The BMA has made another U-turn in the firearms licensing saga, now advising that GPs can conscientiously object to taking part in the process without providing the patient with an alternative.
The BMA’s most recent advice, which followed a number of twists and turns since the firearms licensing process was changed to include GPs in the early stages last year, says GPs can object to participate as long as they follow GMC guidance to take ‘reasonable steps’ to notify patients of their objection.
The new guidance, which also includes clarified advice on putting flags against patient records, said this can include posting a notice on the practice premses as well as on the practice’s website.
GPs have been expected to flag the records of all patients who own a gun – and to inform police if a patient applying for a licence has a mental health problem such as depression – since April last year.
And although the BMA previously said GPs could turn dow this work citing conscientious objection, its most recent guidance published in November said that GPs who refused to deal with firearms licensing requests because of conscientious objection had to help patients find another doctor.
But the new advice goes as far as telling GPs not to put a flag on patients’ records for holding a gun licence at all, ‘due to the imprecise nature of flags, the lack of clear protocols for their appropriate removal and the absence of reliable software to facilitate the surveillance and cross-referencing of flags with diagnoses of concern’.
It also says GPs can reject the police letter for seeking ‘an opinion on matters falling outside my medical expertise, namely assessment of behavioural and personality disorders’.
Previous guidance stated the police letter did not ask for an opinion, however the BMA now emphasises that since the police letter asks whether the GP has any ‘concerns’, it is asking the GP to express an opinion.
The new guidance reiterates previous advice that GPs can charge patients for a response to the original police letter and can refuse to complete the report until payment is received. There is agreement between the Home Office and BMA that a fee can be charged for this, but there is no agreement on the level of fee.
But should a GP believe that someone with a firearms licence poses a danger (to themselves or others) they should ask them to surrender their licence. If the patient refuses, the GP should consider breaching confidentiality to inform the police, adds the new guidance.
And the BMA continues to advise that GPs cannot just ignore letters from the police about firearms licensing as failure to respond could put GPs at ‘professional risk’, as the police department may assume that no response means the GP has no concerns about the patient.
Dr Mark Sanford-Wood, the BMA’s firearms task and finish group lead, wrote a blog accompanying the new guidance saying he was conscious of the ‘distress and anxiety that this episode has caused for GPs’ but that the aim of the guidance is ‘to provide safe, ethical and legally watertight advice to GPs that catered for their wide range of approaches’.
Dr Sandford-Wood also strongly defended the fee that GPs can charge, saying: ‘Any expectation that a doctor will provide this service free of charge represents a de facto transfer of NHS resources from the sick to shotgun owners.’
He added that negotiating changes to the system itself ‘remains a work in progress’ but that the BMA has ‘already had a productive meeting with the Home Office and police representatives who indicate that they are keen to work towards a system that addresses all needs’.
What do GPs have to do with the firearms licensing process?
The firearms licensing process changed in April 2016 which means that police firearms licensing departments now write to GPs before granting a certificate to answer factual questions on the applicant’s medical history and whether the GP has any ‘concerns’ about the applicant being given a firearms licence.
After this initial letter, the police may ask for a full report and there is agreement that police funding is necessary for this.
This system has been mired in controversy, with the BMA maintaining that GPs can charge for the initial letter but the British Association of Shooting and Conservation called on members to refuse to pay this fee. BMA guidance has changed several times.
The BMA provides template letters for GPs to respond to the police letters according to individual preference, with options including refusing to supply a report because of conscientious objection; refusing because it ‘seeks an opinion on matters outside my medical expertise’; agreeing to complete the report, but only once a fee is received; agreeing to provide a summary limited to medical facts once a fee is received; or agreeing to fill out a report without a fee.