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All GPs must help patients obtain firearms licences if requested, BMA says

GPs who refuse to deal with firearms licensing requests because of conscientious objection have to help patients find another doctor, says updated BMA guidance.

The new guidance says GPs ‘must engage in the process of firearms licensing when requested to do so’ and if GPs refuse to engage with the process based on conscientious objection they have to put in place alternative options for the patient.

Since April this year, GPs have been expected to keep a record of all patients who own a gun – and to inform police if anybody develops a mental health problem such as depression.

Previous BMA advice said that GPs may be able to refuse based on conscientious objection to gun ownership but the updated guidance says this refusal would have to be undertaken in line with GMC guidance.

This requires GPs to notify patients of this objection in advance, and if the service is not easily available from another doctor, ‘the GP that objects has a professional duty to put in place alternative arrangements for the provision of the relevant services or procedures without delay'.

The new guidance replaces previous guidance that stated that GPs should refuse all firearms requests after the British Association for Shooting and Conservation (BASC) advised its members to refuse to pay a fee to the GP for this process.

But after discussions with the BASC, the Home Office and taking external legal advice, the BMA has now said that the new guidance ‘takes account of the regulatory obligations on the part of GPs and specifically the requirement to “comply with all relevant legislation”’.

The advice goes onto say that this ‘obliges GPs to cooperate with and agree to facilitate statutory processes in which they have a prescribed role or function’.

The guidance still allows for GPs to charge for firearms licences, saying: ‘However, it is also clear that where a fee for the relevant services has not been provided within the terms of the GMS contract, it may be demanded and that the GP can withhold such services until such time as the fee has been paid.‘

It later says: 'The demand for a fee may form a condition, which if not fulfilled, means the GP can refuse to engage in the firearms certification process.’

The guidance re-emphasises that GPs cannot simply ignore the letter from the police or delay a reply as this places them at professional risk.

This advice only applies to the initial letter from the police, which asks if GPs have any concerns about the patient applying for the firearms licence. BASC still advises any licence applicants to pay if a medical report is requested as part of the licensing process.

Dr John Canning, GPC professional fees and regulation subcommittee chair, said it is 'unacceptable' for GPs 'to take no action at all' when they receive a request.

He told Pulse: 'If someone comes in and says, "I’m a gamekeeper, I’m very depressed and I’ve got a gun and I’m thinking of using it" and I do nothing about it then I’m in grave danger of having to explain myself.'

It comes as GPs received letters from firearms licensing bodies suggesting they could not refuse requests.

The Firearms and Explosives Licensing Department of Hampshire Constabulary wrote that it 'will regard you as having a part to play in the duty of care to prevent harm and loss of life and the management of risk around licence holders'.

Tony Hill, firearms licensing manager at the constabulary, said they 'regard the GP as having shared responsibility with us for the prevention of harm through the use, or threat of use, of licensed firearms'.

He said that if GPs don't engage with the process 'there is a danger that medical conditions that might affect the suitability of a person to possess firearms may go unreported to us'.

He added: 'The possible consequences of this for the patient or others are clearly severe, and it is for this reason that we point out the potential ramifications for these doctors.'

 

 

 

Readers' comments (57)

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  • So when I receive a notification I have to rely on the accuracy of my practice coding and any previous practice the patient may have been registered with (as notes transferred via GP2GP). I then need a failsafe method of flagging up any concerns to the police if my patient develops a condition that I deem to be a risk. If something dreadful happens then I can be blamed for not noticing or notifying something that in retrospect is deemed pertinent. And I'm doing this work when in my day? And for free (as how are we going to invoice, be paid and guarantee a response to the police within 14 days).

    Thanks BMA.

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  • I am none the wiser as to what I am to do???

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  • Damned if we do damned if we dont.Are we qualified to diagnose a personality disorder.Do the police inform the patient there may be a charge involved with this service.There are two many firearms around anyway,It about time the police stopped trying to infer that the gp IS IDEALLY PLACED AGAIN!

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  • For goodness sake - this is an absolutely ridiculous "GPs must". Use of firearms is largely shotguns and is a leisure activity.Having to do things (a la GMC and BMA) to facilitate a patients hobby is outrageously directive and quite frankly none of my damm business. If patients want to spend their days killing pheasants than society can take a view on the safeguards required and sort it out. Compelling GPs to do this is a step too far.What next - forcing us to take patients blood pressure before they play tiddlywinks?

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  • Has the BMA actually reduced any unfunded GP workload???

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  • This is not a health matter. This is not a contractual matter.This is not a court matter. I cannot be compelled to compile a report if I do not wish to.

    The answer then is NO. A letter, a templates of which has done the rounds, should be sent to the local Chief Constable. That is the end of it. It then becomes the Police's duty to find another doctor to 'certify', not yours.

    Seriously BMA support your members don't shaft them!

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  • Dear All,
    Certainly there does appear to be a significant difference from this BMA guidance and the Home Office's own guidance which can be found at;

    https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/518193/Guidance_on_Firearms_Licensing_Law_April_2016_v20.pdf

    You only need to read the last 10 of the 270 pages, the annexes that detail the new process.

    Regards
    Paul C

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  • Dear 5.52pm, could I just mention as a legal firearms owner and a 'retired' doctor and firearms owner, fire arms owners too are being caught up in the middle of all these politics.
    My husband shoots for Scotland (as do I) and he is the captain of a successful Scottish rifle team. He previously competed in the Commonweath games.
    He also is regularly called upon to put severly road injured animals out of their misery.
    He also occasionally uses shotgun. He also uses rifles for stalking deer or rabbits due to the rural nature of his job.
    Please don't forget some have to have firearms licences as part of their work as well as part of their leisure activities.

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  • This requires GPs to notify patients of this objection in advance, and if the service is not easily available from another doctor, ‘the GP that objects has a professional duty to put in place alternative arrangements for the provision of the relevant services or procedures without delay'.
    Would someone at the BMA like to clarify what this aspect of the new guidance means? Assuming all partners at a practice wish to conscientiously object, what alternative is being recommended? I need to have an alternative course of action that I can invoke otherwise I am being forced to engage in a process which I disagree with, which presumably infringes on my human rights.

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  • Tell the patient to piss off and register elsewhere. Problem sorted.

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  • Dear 6.58, Shooting for Scotland and the Commonwealth games are both leisure activities. I can just about accept putting roadkill out of its misery but the numbers of licences required for this activity would be very small and could be covered by a specialised unit.
    Love from 5.52
    PS Stalking rabbits sounds intense!

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  • Great work from the BMA again. Dr Canning should resign.

    It's simple. Non-contractual work I can choose to do. Or not. On receipt of the letter from the police, we send a letter informing them we are declining to participate in a process that would place legal responsibity for us to create a de facto firearms register. We are happy to supply any medical notes to the police with th patients consent and either they or the patient can pay to process this work.

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  • Clear as mud.

    Righto, since I'm now (sort of) told I must participate due to some vague clause in the NHS regulations, and yet at the same time told I can refuse to do this until my fee is paid, that's no problem.

    Given I'm being asked to be the fall guy for anyone with a shotgun who then uses it to kill themselves or someone else, I view that is particularly risky private work. For which my fee to process each licence is £2000. I will be waiting until payment arrives before processing, as per GPC guidance.

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  • Dear fire arms people. I can confirm that I am a practicing GP at Mr Shooty's surgery and have access to most of his notes at least most of the notes that has been placed upon his computer records, most of the paper records are falling apart and look like they've washed up ashore and have been pulled out of a wine bottle. I don't know for a fact that he is a psychopath at least its not coded on our system. I heard through the grapevine that he did a lot of shouting and swearing when his football team lost an important game i'm not what that says about his temperament. Anywhoo's I have no idea as to whether he'd be safe to own a gun or not but my basic understanding of the matter is that generally they can be pretty dangerous and if in the wrong hands can lead to a pretty nasty case of death and I'd prefer it if nobody owned a gun or kept one in their homes. Here is a bunch of his notes for you to read through at your leisure most of it if not all is completely irrelevant. . Just to be clear I have no opinion on the patients ability to safely manage firearms now or in the future. My invoice for this report is listed below

    Many thanks Dr P Acifist

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  • Pity women requesting an abortion are not protected as much as people wanting to own a gun.

    Powerful lobbies and BMA covering their own backsides......yet again

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  • Your headline is plainly wrong and misleading. GPs are being advised that they must not just ignore letters regarding firearms cerificates, but it is reasonable to make a charge and not to reply until it is paid, or to refuse on concientious gounds (as long as you have notified your patients in advance).

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  • Took Early Retirement

    GP Partner15 Nov 2016 5:52pm

    I am retired as a GP. I have a modest land holding. I use my shotgun and small-bore rifle exclusively for vermin control. It's not really a leisure activity.

    I can't think of anything much more pointless than standing in a cold, muddy, field waiting to pop at pheasants as they fly past. Many people would disagree with me on that, of course, but I feel the same way about fishing when you can buy trout for a few quid a kilo in Tesco.

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  • This is a responsibility we need like a hole in the head.
    Ummm....

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  • Vinci Ho

    You see
    In my long comment a few days ago about Brexit on GP recruitment , I referred to the possibility to challenge this betrayal to NHS and hence GP by this post Brexit government for the money promised during the referendum ,
    ''......Perhaps , this opportunity of going through the parliament to lay down all conditions for Brexit is the last chance to ensure NHS will not be sacrificed as a price for the final destination. Our representatives will have to go furthest, by any imaginable means , to ensure NHS survival is one of these conditions to be laid down in House of Commons debate.......I am pessimistic. ''
    Interesting , some of the usually pro-government organisation like King's Fund is 'relatively militant' in criticising the government ......
    We are where we are , who am I to judge these people ?

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  • What a load of old crap.
    If a Dr conscientously objects to firearms ownership (many good reasons why), then they should naturally also object to facilitating it through passing to another Dr.
    If its a hobby then keep the guns securely on shooting ranges. Shooters- don't moan about the cost of licensing- its a hobby- plenty other hobbies are expensive- get over it or stop doing it. I see enough people on my daily journey who struggle with the cost of living, never mind leisure pursuits.
    If you're a gamekeeper- get your boss Lord Pompous to pay for the privilege. He earns enough from charging bumbling old yahs £5000 a day for firing vaguely in the direction of grouse.
    Plenty of much more important stuff to do at the moment without this utter nonsense.

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  • @8.30 am
    Can you explain why all of a sudden it has suddenly become a GPs job to become unnoficial and largely, unpaid policeman of the gun owning classes? The GP, who will cop it when something inevitably goes wrong.
    What level of responsibility do you have as an 'other healthcare professional'

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  • Gosh, "gun owning classes"????
    Just let it all out, don't bottle it up now.

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  • Dear TWIMC, we are not compelled to complete non-contractual work, however, in order not to adversely impede the application for a firearm, nor to overlook any serious health issues, we draw your attention to the fact that the records of the applicant are available, please inspect them at your leisure, or proceed to your own formal examination and assessment of the applicant, kind regards

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  • Jonathan Pywell | GP Partner15 Nov 2016 7:01pm

    You forget Doctors don't have human rights!

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  • @9.34am
    I see you didn't answer the questions.

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  • The wrongs or rights of this are good to debate.
    Doctors do have human rights but so do people who own guns.
    Gun owners are continually victimised in many ways for their use of guns in their sport/hobby/occupation and have been for years.
    Hopefully a workable solution can be found which works for all party's without so much negative emotion.
    Unfortunately the government has sacked the majority those in the police force who understand and previously licenced firearms, to save money! It was not the fault of the firearms owner this happened. Just one of the many government cuts which are taking place everywhere. Gps and all doctors, myself included, know much about cuts.
    Soon all gp services will be for fees, when the NHS collapses.
    Firearms holders have to have a spotless record to own and keep a firearm. They are just ordinary people trying to live, like everyone else. They already accept they need to pay for a firearms licence, which they already do under current rules.
    Hopefully with good will on all sides, a way forwards can be found to resolve this issue.

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  • I think youll find goodwill is long gone. These are the same patients who wouldnt bat an eyelid sueing any of us if we make a mistake despite how small, in the context of working in an unsafe environment.


    no work done by people who are not skilled to do so - we cannot determine who is fit to hold a firearms license, nor can we be held responsible for telling the police if a licenseholder gets mental health issues in the future. i agree with much of the above - charge the force for cost of all the notes, and let them make their minds up.

    please remember - most of our population knows its rights and not its responsibilities, and this is why we are crumbling to a halt.

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  • Why can't a system similar to that for driving licences be put in place. Both lethal weapons.
    Call it the "GLA" ie. gun licensing authority.
    They issue licence, they do the regular checks, patient under obligation to inform of altered circumstances.
    We provide factual information or alert the "GLA" as appropriate as we would the DVLA.

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  • hopefully we will see this new guidance soon Is there a link available?

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  • I'm self employed
    I can decide what I do!

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  • There actually was a form of Gun Licencing Authority. However the government put paid to this and sacked pretty much everyone in it (in Scotland anyway). This system worked well as everyone knew how to do things properly. Most the officials were ex-policemen anyway.
    The savings were maid so that more police would be put on the beat to fulfil prior promises.
    Unfortunately the police left with this specialised work are regular bobbies wich little or no previous expeirence. They have to do this together with all the rest of the types of work police are ment to do. So they will never have much accumulated experience in this area. This makes it harder for legitimate gun owners as they have to deal with people without the extensive knowledge that the previous people had, which leads to more problems.
    So yes it was a good idea and hopefully it will be re-intoduced again (hopefully with many of the poor folk who were forcibly made redundant) sometime but I am not holding my breath.

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  • the reading ofparagraph 5 of the article suggests to me to mean that if it isn't specified in the GMS contract and paid for,we dont have to do it until it is ?

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  • WHAT is definition of mental illness . if patients says he is stressed then report to police he has mental illness?? "today i examined him/her and he had no mental illness. tomorrow i can not predict my own mental state never mind my patients as i don't know him personally. this is what one should write.

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  • Well done BMA. After totally ballsing up the junior doctors contract you have now landed this on us. Absolutely useless. Sack yourselves and then sack yourselves again

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  • Does the headline not invite the obvious reply......

    .....or else what?

    It's time we started calling some bluffs.

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  • I shoot - for pest control, for the pot, and honestly because I am good at it, the anilmals die quick and clean, and far far better than in an abattoir by ritual slaughter, and it gives me a reason to be out in our glorious countryside doing some good. ( yep, good... as without control the deer would increase exponentially and you would not only have no roses but also no Caledonian forest, and no woodland sssi's.)

    I will shortly need a fac.

    As a shooter i want you to participate as GPs cos if my neighbour is a nutter i really really dont want him having a gun.

    As a GP i think the whole thing is a pigs ear, a legal nightmare, and now legislates that we do the undoable ( Wheras previously it was left to goodwill and common sense)

    Will the world please sort itself out?

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  • They can't hold a gun to my head.......

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  • For me the statement from Hampshire police quoted in the article does not surprise me. They have been sending letters along with their request for information stressing that we hold joint responsibility for ensuring safe gun ownership.

    I am happy to provide information on medical history (for a fee), but I in no way accept any such joint responsibility.

    Having briefly shown some backbone, the BMA appears to have reverted to type. Whilst they may be acting correctly from a legal perspective, the statement from John Canning fails to recognise the feeling in the profession with regards to the issue.

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  • Such dictatorial proclamations / commands from the BMA is exactly why I am now happily practicing medicine in South Australia.

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  • Joint responsibility for ensuring safe gun ownership?? I've not read that for them a. If that's the case write back saying that we have a blanket policy that no gun ownership is safe. Here are the patients medical records that he/she has allowed us to release. Here is our fee. If the patient has a new problem you would like us to inform you about we can send you his updated records as long as the patient agrees... And for another fee of course. Alternatively you could leave us alone and decide yourselves who you hand out your guns to.

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  • ED: Thank you for using a far more appropriate photograph at the top of this story. Shotguns are all about rural life.

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  • BOTTY WIPING POLICE.

    Due to the increase in sore bottoms due to inadequate wiping post-defaecation particularly in overweight and elderly patients it is now advised that after opening bowels patients book an urgent appointment with their GP to be checked for any faecal remnants and to have them removed by an expert (GP).

    Sounds ridiculous but you never know where the responsibility of GPs will end when patients have virtually no responsibility themselves.

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  • The patient this morning told me flat : Can you please check my bp today because in two days I'll be seeing my proper doctor - o yes, the last time they had the MDT meeting in hospital there were two doctors and one GP. Ahem, message taken, GPs are not proper doctors but we are happy to the excreta is cleared.

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  • If this comes into force (monitor firearms for a potential deterioration and take the blame for an incident if occurs) I'm resigning as a partner.

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  • The GPC has done us a disservice in seemingly negotiating this extra bit of work and responsibility for no fee.

    Please join me in writing to your local firearms service and insisting that GPs are paid a fee by the firearms authority (not the patient).

    The argument runs like this:
    1) Providing reports to the police is not part of our contractual responsibility.
    2) The police charge members of the public for administering their shotgun application -around £120 currently.
    3) The police feel that they need to tighten their policy and want us to search through medical records and generate a report to them.
    4) This request for a report comes from the police (not the patient) and is sent to the police therefore they have to incorporate the costs for this service in the fees they already charge for administering the scheme.
    5) Incidentally I have also made it clear that the practice has not agreed a timescale with them, that they cannot assume that if we have not replied within a certain timescale that we have made a check and that we have no concerns, and to stop making requests for reports until a framework has been agreed.
    6) I also point out that the read codes that we use on patient records are nothing to do with the police, and form part of the medical records. Likewise we would have no jurisdiction requesting that the police enter data on patients criminal or police records.
    7) I point out that as good citizens we will continue to report concerns to them as we always have.

    If local groups can negotiate we have a chance with not being totally stitched up on this one.
    Clearly GPs will get drawn into the next Dunblane event medicolegally, and we need to be compensated for taking this additional risk on.

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  • Totally agree Dr Greenway.
    This is a good template which local LMCs should apply to each police force. A request should generate the above automated reply, and when they have paid appropriately then the work will be undertaken. As you point out the Police are already being paid for this

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  • I hope the few dwindling members of the BMA can finally put the nail in the coffin and should leave.
    It just goes to show the BMA needs scrapping and a new organisation founded.

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