Gun licence application

Business Dilemmas

Dr Kathryn Leask

Dr Kathryn Leask explains what to do if you are asked to complete documentation in relation to a patient requiring a firearms licence. 





Dilemma 1

Can you advise on gun licence?

Q I have been seeing a patient for a number of years at my private GP practice. He has various physical health problems and has suffered from some work-related anxiety in the past. 

I have received documentation from the police asking whether I have any relevant information about the patient, as he has applied for a firearms licence. As I have not been asked to do this before, I wonder if you could help advise about the process.

A In April 2016, the Home Office updated guidance on firearms licensing arrangements, and this included revised procedures relating to the health and fitness of licence-holders. 

The Government’s main website on firearms licensing is a good source of information. The Home Office also has a Guide on Firearms Licensing Law.

Your role is to share any information which you have reason to believe is relevant to the police’s decision-making process. What is relevant is based on your judgment. You should be prepared to justify why you did or did not disclose particular information if you are asked to.

In considering what information to share with the police, you should keep in mind that anything you send them could be seen by the patient if they are subsequently denied a licence and appealed the police’s decision. 

Factual information

It is better, therefore, to provide objective, factual information, which would be in line with the GMC’s Good Medical Practice.

This says that you must make sure documents you sign are not false or misleading and that you have taken reasonable steps to check the information. It is also important that you do not deliberately leave out relevant information.

The patient is likely to have already consented to the disclosure of medical diagnoses when they completed the firearms certificate application. 

If you were considering sharing information other than medical diagnoses, you would then need to consider discussing this with the patient. That would be either to get their consent or simply to inform them of your decision, if you feel that disclosure is required to protect the public from serious harm, as outlined in the GMC’s Confiden­tiality guidance. 

Although ultimately the decision is yours, as well as discussing what might be relevant to the police with your colleagues, you may also wish to contact your defence body.

Collapse due to eating disorder

Dr Kathryn Leask

Dr Kathryn Leask discusses how to respond to a complaint involving a patient diagnosed with an eating disorder.





Dilemma 2

How do I react to this complaint?

QI am a private GP and have just received a complaint from the partner of a 37-year-old female patient who presented to me with vague symptoms includ­ing weight loss and dizziness. 

She was a keen sportsperson and had a good exercise tolerance, which was reassuring. 

I conducted a number of investigations including various blood tests, all of which appeared normal. Unfortunately, she collapsed at home and was admitted to hospital. 

According to her partner, she has been diagnosed with an eating disorder and is now under the care of a psychiatrist. 

I hadn’t suspected this at all. How should I best respond to the complaint? The partner has intimated that he intends to refer me to the GMC.

A At this stage, you can acknowledge receipt of the complaint, but you will need consent from the patient before you can respond to her partner. 

However, you can begin your investigation into the complaint. It is important to review the care you provided from the beginning of this clinical episode to identify areas of good practice and areas where, with hindsight, you could have done things differently. 

If possible, discuss the complaint anonymously with a trusted clinical colleague or with a peer group. Would they have done anything differently? You can seek advice from your defence organisation with drafting a suitable response once you have the patient’s consent.

While you can’t stop a patient or complainant raising concerns with the GMC, you can pre-emptively take positive action by showing insight into the concerns and taking remedial action.

Good opportunity

All complaints and clinical incidents are a good opportunity to review your knowledge and skills. As you didn’t suspect an eating disorder, part of your reflections on this case could include speaking to a specialist in eating disorders and then providing a teaching session to your peers, for example. 

You should also review the relevant guidance in this area, such as the NICE guidance. In addition to this, the Royal College of Psych­iatrists has produced guidance on the recognition and management of medical emergencies associated with eating disorders. 

As well as reassuring the patient that you’ve taken the complaint seriously and used it as an opportunity to improve the care you provide, the GMC also tends to look favourably on registered medical practitioners who proactively address any concerns, meaning that there is a higher likelihood that they may close their investigation without the need to take any further action.

Dr Kathryn Leask is a medico-legal adviser at the Medical Defence Union