BMA calls for clarity on GP role in new firearms licensing guidance due within ‘weeks’

The BMA has called for further clarity on GPs’ role in firearms licensing after the home secretary said they would take a mental health ‘assessment’ role in new statutory guidance due within weeks.

The issue has come to the fore after last week’s mass shooting in Plymouth, which saw licensed gun holder Jake Davison kill five people, including a three-year-old girl who was not known to him. According to reports, Mr Davison had lost his gun licence last year after being investigated for assault, however was handed back his licence last month.

Speaking after the tragedy, Priti Patel said: ‘We must do all that we possibly can to avoid something like this happening again.’

She said this includes ‘bringing forward new statutory guidance to improve how people applying for a firearms licence are assessed in future’, while the Home Office plans to ‘publish this guidance in the coming weeks’.

She added: ‘It will mean that no one is given a firearms licence unless their doctor has confirmed to the police whether or not they have any relevant medical conditions, including an assessment of their mental health, and it will make explicit that firearms applicants may be subject to social media checks.’

The Home Office will ‘keep the new statutory guidance under review, especially in light of this terrible incident’ and ‘will update it as necessary in due course’, Ms Patel said.

But Dr Mark Sanford-Wood, the BMA’s lead on shotgun and firearms licensing policy said: ‘[W]e really need to see the detail behind that assertion. It’s a declaration full of promise and assurance but for it to be effective, doctors need to be involved in the mechanics for making it work in practice and for there to be an agreed standard process across England.’

And while the BMA welcomes the guidance being published ‘without further delay’, the doctors’ union believes there are a number of issues which still need to be resolved.

Dr Sanford-Wood said: ‘Many letters from firearms licensing officers to GPs ask the doctor to place a “flag” in the patient record to identify the subject as the holder of a firearms license. We support this in principle but as with the sharing of patient information, there are practical concerns that we have raised with the Home Office and which need the Department of Health and Social Care to resolve before the system is safe to use. 

‘For example, it isn’t clear under what circumstances that flag could be removed and there isn’t currently any reliable software to facilitate the surveillance and cross-referencing of flags with diagnoses of concern. The BMA has been working with NHS England and relevant IT systems suppliers to rectify this and provide further safeguards.’

Dr Sanford-Wood said the BMA ‘is more than keen to see’ the new guidance published because ‘it should support a system of firearms licensing that allows only the most suitable candidates to hold a license and most importantly, help keep all of us safe’, but stressed that in order for it to be effective it needs to be ‘correctly drafted and properly applied’.

He added: ‘Doctors at the BMA have had and continue to have significant involvement in the development of Home Office guidance on firearms licensing because our priority is, first and foremost, public safety. Gun ownership is a privilege and not a right; firearms and shotguns must be in the hands of only the most safe and responsible people.

‘But the guidance [is] not a cure all. We also need more resources to help all of those involved in deciding who does and does not get a licence and how or when it is time to revoke it. The police and doctors somehow must find the physical and emotional time and commitment to assess whether someone is truly capable of being licensed to own something, which if not used safely, can cause damage that may never be repaired.’

However BMA’s professional fees committee chair Dr Peter Holden, a former lead negotiator on the issue, told Pulse that the home secretary’s claims regarding mental health assessments were simply incorrect.

He told Pulse that the BMA has ‘an absolute written assurance’ that ‘the responsibility for licensing is, in all cases, the chief constable’s, and liability cannot be landed at the GP’s door’.

He said: ‘There is no truth in the suggestion that GPs are going to have to offer an opinion or assess people psychiatrically.’

He added that GPs will only ‘have to supply information’ on applicants’ mental health ‘if they have got it’.

This corresponds with a draft version of the new guidance, published for consultation two years ago, which had said police officers – and not GPs – would be legally liable for judging whether someone is able to possess a firearm, and for checking medical records of applicants.

GPs will still be asked to provide medical information if a firearms applicant has a history of relevant mental or physical conditions. They will also be asked to alert the authorities if their patients develop a medical condition that could affect their ability to hold a firearms licence after it has been issued, according to the draft guidance.

A key change would remove police departments’ ability to grant firearms licences in instances where they do not hear back from an applicant’s GP, however.

Dr Holden also suggested it would say firearms licence applicants have to be registered with an NHS, rather than a private, GP.

Current guidance from the BMA states it is ‘important’ for GPs to respond to the police within 21 days of receiving a request for information about an applicant, and that ‘a failure to respond could put you at professional risk’.

GPs are not contracted to provide this service under the GMS contract, but are able to charge applicants a fee for processing the report.

The BMA offers sample letters and says that GPs responses can include a refusal to provide a report due to ‘a conscientious objection to the holding of firearms’.

However, RCGP president Professor Dame Clare Gerada suggested GPs’ role in firearms licensing should be removed altogether.

She told Pulse: ‘It should not be the GP’s responsibility to sign a gun license, any more than it is my responsibility to sign someone off as fit to run the Paris marathon.’

According to Dr Gerada, gun licensing as well as other signing off GPs are asked to do – such as whether people are fit to run a marathon, do a skydive or should be exempt from wearing a mask – ‘should be taken out of our hands’.

‘I just think it’s so easy to sign but the consequences can be catastrophic, if you are held liable for whatever goes wrong,’ she said.

‘It’s not for me as a GP to say whether somebody is fit to hold a gun license, I have no idea that somebody’s whether somebody’s fit to hold a gun license. I don’t believe anybody does have any idea.’

She said: ‘In the last three weeks I’ve been asked to sign off a back brace, child modelling, a seatbelt exemption, a pregnant woman wanting to fly, endless mask exemptions and endless Covid exemptions.

‘GPs are the only ones that do it. People do not realise the increasing litigation that we as GPs are putting ourselves at risk from. And I think the BMA should be looking at all of these.’

The Home Office declined to make a comment on the BMA’s claims.

Click to complete relevant mental health CPD modules on Pulse Learning.