Memorandum submitted by the British Medical
Association
EXECUTIVE SUMMARY
— Doctors' involvement in this area is
complex. Doctors can identify that patients hold firearm or shotgun
certificates in several ways. They can be asked to act as a referee
or counter-signatory, they can be approached by the police in
order to obtain factual information about the applicant for such
a certificate, or it can emerge during consultation.
— Doctors owe a duty of confidentiality
to their patients, but such a duty is not absolute. Where doctors
have a reasonable belief that an individual in possession of a
firearm may pose a threat of serious harm to himself or to others,
this information can be disclosed without consent.
— Not all patients who hold shotgun or
firearm licences will make that fact known to their doctors.
— The BMA is concerned about an increased
role for doctors in the supervision of certificate holders due
to the difficulty of assessing the future dangerousness of certificate
holders. Any proposed changes to medical involvement in firearms
control must be prefaced by full consultation with the medical
profession.
ABOUT THE
BMA
1. The British Medical Association (BMA)
is an independent trade union and voluntary professional association
which represents doctors and medical students from all branches
of medicine all over the UK. With a membership of over 143,000
worldwide, we promote the medical and allied sciences, seek to
maintain the honour and interests of the medical profession and
promote the achievement of high quality healthcare.
MEDICAL INVOLVEMENT
IN THE
PROVISION OF
FIREARM OR
SHOTGUN CERTIFICATES
2. The medical role in the provision of
firearm or shotgun certificates is not straightforward, and this
needs to be taken into account when considering any potential
reform of information-sharing practices.
3. Doctors can be involved in such certification
in a number of ways. Applicants can ask doctors to act as a referee
for applicants for firearms or as a counter-signatory for a shotgun
application. For both of these applications, doctors can act as
one of a number of "persons of good standing". Any such
person acting as a referee for a firearm is required to complete
forms relating to the mental and physical health and welfare of
the individual and whether there are any causes for concern. Counter-signatories
for shotgun certificates are requested to confirm that they know
of no reason why the applicant should not be permitted to possess
a shotgun and to "bear in mind the character, conduct and
mental condition of the applicant in so far as they are relevant."
In addition the police may request information from a patient's
GP in order to obtain factual information about the applicant's
medical history. Doctors may also learn about whether a patient
holds a certificate during a routine consultation. It follows
from this, therefore, that GP's will not always be aware that
a patient possesses a firearm or shotgun certificate.
BMA CONCERNS ABOUT
MEDICAL INVOLVEMENT
IN THE
PROVISION OF
FIREARM OR
SHOTGUN CERTIFICATES
4. Although Home Office guidance limits
the role of the counter-signatory or referee to the provision
of information and opinions police can take into account when
making a decision, the BMA has some concerns that an excessive
emphasis may still be given to endorsement by a doctor because
of the specialist nature of his or her expertise. Doctors who
have contacted the BMA with concerns about this process point
out that they very rarely have sufficient knowledge of an individual
to certify that he or she has not suffered from any mental disorder,
nor will they be able to give a meaningful medical opinion on
more general issues such as the "character, conduct and mental
condition" of the applicant. The BMA therefore advises doctors
that where the applicant is not their patient, there is nothing
to stop them from endorsing an application, providing this is
made clear. Where the applicant is a patient, the BMA advises
doctors not to endorse applications unless they have a sufficiently
detailed knowledge of the patient's mental and physical health
to be confident that the individual can safely possess a firearm.
In the BMA's view, few doctors are likely to have this level of
knowledge.
MANAGING FUTURE
DANGEROUSNESS
5. A key aspect of firearms control is the
ability to manage risk, in particular the ability to assess likely
future dangerousness. In the BMA's view, the likelihood that an
individual will present a risk of harm in the future is extremely
difficult to predict, as the best indicator of future behaviour
remains prior behaviour. The BMA would therefore be extremely
concerned if responsibility for managing the risk presented by
individuals with shotguns and firearms were transferred to the
medical profession. Any intended changes to this process must
be prefaced by consultation with the profession.
INFORMATION SHARING
6. Doctors owe a duty of confidentiality
to all their patients. The duty is not absolute. Where there is
a reasonable belief that an individual either applying for a firearm
or shotgun licence or already holding one, may represent a danger
to themselves or others, the BMA advises doctors to strongly encourage
the applicant to reconsider or revoke their application. If the
applicant refuses, doctors should consider breaching confidentiality
and informing the police firearms licensing department as a matter
of urgency.
"TAGGING"
MEDICAL RECORDS
7. Following a coronial inquiry into a firearms-related
death, in 2009 the BMA was involved in discussions concerning
the desirability of GPs placing electronic tags in medical records
to indicate that the patient either held a firearm or shotgun
certificate or had applied for one. In the BMA's view such an
approach can be appropriate, provided it is used as part of the
ordinary care given to a patient. Any such system must not, however,
imply that the GP or practice has taken on particular obligations
to monitor the threat presented by the patient.
25 August 2010
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