Digital Firearms Marker

You need a firearms certificate issued by the police to possess, buy or acquire a firearm or shotgun. The new Digital Firearms Marker has been created to help make the application process safer and to streamline the process for GPs.

Following the publication of new Home Office statutory guidance, which came into effect on 1 November 2021, NHS Digital have worked with the Department of Health and Social Care, Home Office, the British Medical Association (BMA), Royal College of General Practitioners (RCGP) and other stakeholders to design it. 

GP practices should add the appropriate SNOMED code to a patient's record when they receive notification of a firearms certificate application, or when a certificate is granted. This will now create a Digital Firearms Marker on a patients record, which will generate an alert if a potentially relevant condition is added.

The new statutory guidance about firearms licensing. The new guidance reaffirms that gun ownership is a privilege, not a right, and clarifies the importance of the GP surgery that holds the gun owner's primary care record in the process to help ensure that only those who are suitable are granted a firearms license.

In 2019, the Home Office signed a memorandum of understanding with the National Police Chiefs Council (NPCC) and the BMA to reaffirm the responsibilities of doctors.

This stated that:

• the legal responsibility for monitoring firearms holders’ rests with the police, however, doctors should use 'reasonable endeavours' to support the process
• this would normally include placing a marker in the patient’s medical record to alert clinicians to the patient’s status as a firearm licence holder
• doctors are required to provide statements of fact and not opinions during the application process, with the police firearms branch making the judgement on the issuing of the firearms license

The new marker helps to support these reasonable endeavours by doctors and makes it easier to identify patient medical conditions which may be relevant to the firearms licensing process.

There are a range of medical conditions which must be disclosed on a firearms license application. 

These include but are not limited to:

• acute stress reaction or an acute reaction to the stress caused by a trauma, including post-traumatic stress disorder
• suicidal thoughts or self-harm or harm to others
• depression or anxiety
• dementia
• mania, bipolar disorder or a psychotic illness
• a personality disorder
• a neurological condition: for example, multiple sclerosis, Parkinson’s or Huntington’s diseases, or epilepsy
• alcohol or drug abuse
• any other mental or physical condition, or combination of conditions, which you think may be relevant

The Firearms Trigger Concept Simple Reference Set (FTCSRS, or ‘trigger reference set’) is a list of digital codes that are used in GP electronic health records to represent these conditions. The full list is accessible as a downloadable spreadsheet at the bottom of this page.

GP surgeries will now consistently be able to identify the cohort of their patients who currently hold a certificate for firearms. 

The Digital Firearms Maker reference set is the first attempt to articulate in detail which conditions are considered relevant in assessing suitability to hold a firearms licence. GPs will benefit from a support tool that finds and presents information potentially relevant to an individual's suitability to own a firearms licence. 

This will improve the completeness with which a GP can present relevant factual information to the police during an application.

The marker also reduces the risk that a GP surgery is unaware that a patient with a current firearms certificate has developed conditions which may require review by the police.

This will make it easier to proactively monitor the suitability of firearms license holders and reduce how often citizens retain their licence despite having become unsuitable.

When a patient applies for or is granted a firearms license, the GP will add the appropriate SNOMED code to a patient’s medical record. This will create a Digital Firearms Marker on the medical record.

There is no requirement for GPs to retrospectively review existing patient records to identify firearms holders or applicants who have not been coded as such. 

Once the Digital Firearms Marker is applied it will automatically trigger an alert to the GP when a triggering condition is added from the Digital Firearms Marker reference set.

There are two situations when an alert will appear in a GP clinical system:

A pop up appears in two different situations:

1. When a new firearms license application has been recorded in the electronic records of someone who has a condition from the Digital Firearms Marker reference set in their records.
2. When a new, potentially relevant, medical condition from the trigger reference set is added to the records of someone who has a current licence or has had a licence application recorded in the past six months. 

The alert itself may appear differently depending on which system is being used but, in all cases, it will provide guidance on what is expected. 

The trigger reference set contains many terms and was designed to be highly sensitive. This may mean that a significant number of false positive conditions trigger the alert that do not ordinarily need to be reported to the police. 

If the GP considers all of the relevant information is known to the police, or that the information triggering the alert is not sufficiently relevant to require notification to the police, they should record that they have reviewed the record using the appropriate code, and record that no action is required on clinical grounds.

Where a new condition of concern is added to the records of someone with an existing licence or with an application in progress, the GP should contact the patient to advise them that they must contact the police to update them with the new information. If there is a public safety concern, or if the GP believes that the patient has not or will not inform the police, then the GP should contact the local police firearms branch themselves (or telephone 101) to report the new diagnosis. They should inform the patient that they (the GP) will be doing this.

Consent for information to be shared with the police in this situation has already been granted by the patient on their original firearms license application.

If a condition of concern is filed to a patient record in such a way as the marker is not triggered, for example when filing an incoming document or data message via a third party software, no alert will pop up, but the patient will be found in the practice searches that are deployed with the marker. If the patient record is reviewed, the user will be alerted that there is an outstanding firearms safety review needed.

Individual system suppliers (TPP, EMIS, and Cegedim/Vision) will have guidance on how to run searches within each system. 

As set out in the Home Office statutory guidance, it is the responsibility of the applicant to arrange for information about their medical history to be provided by their GP (or another suitably qualified doctor fully registered with the General Medical Council) to the police firearms licensing department dealing with a new application.

Where a new condition of concern is added to the records of someone with an existing licence or with an application in progress, the GP should contact the patient to inform them that they must contact the police to update them with the new information.

If there is a public safety concern, or if the GP believes that the patient has not or will not inform the police, then the GP should contact the local police firearms branch themselves (or telephone 101) to report the new diagnosis. They should inform the patient that they (the GP) will be doing this. The medical records should be annotated (using a code from the FTCSRS) to indicate that the police have been informed or that the patient has been asked to inform the police.

The wider legal duty to protect the health of patients and the public is one reason why doctors may need to provide confidential information about their patients to the police even without their consent.

GPs may share relevant information directly with the police for all the following reasons:

• the patient has already consented to this when they applied for their license
• on public interest grounds
• (in some rare circumstances) if it is legally required

In these cases, the doctor or GP should contact the relevant firearms licensing authority.

If the GP surgery becomes aware that a person who was a firearms or shotgun licence holder has died, they are also asked to inform the police. This is so that the police can take the necessary action to ensure that the firearms are secured, and the firearm licence be cancelled

NHS Digital, alongside other stakeholders, will monitor the performance and effectiveness of the Digital Firearms Marker and look for opportunities for iterative development in the future. This will include considering individual user feedback and suggestions.

The codes contained in the reference set will continue to be refined and updated for future releases.

GP surgeries who have queries regarding the Digital Firearms Marker technology should raise these with their GP clinical system supplier in the usual way.

Any queries related to policy, the reference set, or other feedback about the marker should be sent to NHS Digital: [email protected]. Please include ‘Digital Firearms Marker’ in the subject line so we can identify the messages quickly.