Kent LMC Firearms Guide - Questions and Answers (Nov 2022)
The current process for firearms licensing was introduced on December 2021. This stipulates an applicant MUST produce a completed Standardised Medical Information Preforma with the application. Licence holders must renew their licence on a 5 yearly basis, the firearms team notify applicants 12 weeks prior to renewal.
The legal responsibility for monitoring firearms holders rests with the police, GPs should use 'reasonable endeavours' to support the process as stated in memorandum of understanding between National Police Chiefs Council and the BMA.
Does a GP need to contact the patient to complete the Standardised Medical Information Proforma?
No, there is no expectation to see or consult the patient the requirement is for a GP to assess the medical notes (the entire GP record including paper notes if not fully digitised) to identify relevant medical conditions. However, you can contact the patient if you wish.
What medical conditions are relevant?
The medical information is key to the police decision. The GP must list any of the conditions detailed on the form BUT the list is not exhaustive. For example, terminal diagnoses or anything else you consider may impact mental state. This should include past diagnosis eg depression even if the patient has fully recovered.
What should go in the additional information section?
The answers to the questions on page two of the GP report will provide the Firearms Licensing Manager with invaluable information. Particularly in mental health conditions enabling a picture to be built of the applicant, their motivations and the background or trigger factors i.e., marital problems, domestic violence, financial worries, work stresses, bereavement etc.
What level of detail is needed?
This is a difficult one. The information boxes allow for a summary of identified relevant medical conditions. The Firearms Licensing officer will approach you if more information is required. You can include other patient correspondence eg letters from other providers.
Do I need to identify alcohol intake?
Drug and alcohol abuse do need to be identified when present in current or past in medical nots, however GPs are not required to proactively enquire about current alcohol intake. The Firearm team specifically ask applicants at interview prior to grant / renewal of licence questions around alcohol intake and drug taking.
Do I have to complete the Firearms Standardised Medical Information Proforma?
If you object on moral grounds you are not compelled to complete the form we would recommend in the first instance, asking a colleague in your practice. If this is not possible the applicant can apply to a ‘third party provider’ and will require a SAR sent to them directly.
My patient has applied to a third-party provider to have their Standardised Medical information Proforma completed, what are my / the practice responsibilities?
Current guidance is that when asked by the applicant/ patient the practice has to provide a Subject Access Request directly to the third-party provider. We acknowledge that this is far beyond the original intention of SAR and is an issue we are campaigning for clarity and change on.
What is the ongoing GP responsibility for patients with a Firearms License?
When a licence is granted, the practice will receive a letter from the firearms team instructing the SNOMED code ‘Has Firearm Certificate’ is inserted as a minor, active, indefinite problem. This ensures that there is clear visibility on the problem list to clinicians consulting patients with firearms licence and enables the firearm alerting system in EMIS to flag up if a relevant new medical condition SNOMED code is entered. Currently the role out of the flagging system in EMIS is paused will testing is carried out, we are advised the flagging system will be activated in January 2023, in the meantime please be aware that in most practices there will be no active flagging system in EMIS.
What happens if a patient with a firearms licence develops a relevant medical condition?
If a new diagnosis or change in circumstances means a patient meets criteria for a relevant medical condition the applicant has the onus to report this to the firearms team. This does not mean the licence holder will necessarily lose their firearm, but the firearms police team will conduct a risk assessment. In some situations, GPs may feel the need to flag an issue directly to the firearms team. We recommend in most situation indicating to the patient you are going to do so but you do not breach confidentiality of the patient by doing so without their permission.
How do GPs contact the firearms team if I am concerned a patient has developed a relevant medical condition?
The onus of this will remain with the patient/applicant however GPs can contact the police via email for non-urgent concerns the response time is approximately 5 working days. You do not need the consent of the patient to do this but according to circumstance you may wish to inform them
Please include the patient full details and a description of the medical condition. Please ensure a copy of the email is entered into the patient notes (but without patient visibility).
If you have an urgent concern posed by a patient with a firearm, please phone 999
What happens if an applicant / patient or GP reports a concern to the firearms team?
A risk assessment process is completed, and the firearms team will send (usually in person) the most appropriate response according to the level of risk. This does not necessarily mean the firearms officers with body armour and firearms if the risk is deemed by the police as low and alternative police resources are available. The police will then conduct an interview assess risk and make a decision to remove the firearm or if it can remain with the applicant. If the firearm licence is revoked and the firearm removed the firearms team will send a letter to practices indicating of the case.
What do practices do if a patient / applicant has a firearms licence revoked ?
The firearms team will write to the practice confirming the firearm has been remove, the letter prompts practices to enter the SNOMED code ‘No longer has firearm certificate’ which removes the patient record from the firearms alert flagging system.
Can I charge for completion of Standardised Medical Information Preform for firearms licensing?
Yes we recommend practices charge for this service as it is outside of your NHS contract. The price should reflect the time taken for adminstartive time to process the form and clnicians time to review the entire medical record which includes non digitised/paper notes. The BMA recommends a 21 day period from recieiving the request to producing the completed report.
Is increasing age a relevant medical condition ?
The anwer to this is no, as this would be classed as aged discremination, historically there were more checks carried out in older applicants but the current licensing relies on relevant medical information
A few tips…………..
We recommend all practices scan a copy of the completed proforma into the patient record.
We are informed by the police that signficant majority of firearms are by default law abiding citiziens who have to be interviewed and other evidence is used when granting a firearms license. Reassuringly the firearms team indicate that licence holders are reporting new relevant medical conditions.