Assessing fitness to drive

Patients have a legal duty to inform the DVLA about their condition, explains Dr Lynda Carter.

Patient information can be disclosed if a GP feels the patient may expose others to risk when driving
Patient information can be disclosed if a GP feels the patient may expose others to risk when driving

Driving licence holders have a legal duty to inform the Driver and Vehicle Licensing Agency (DVLA), or the Driver and Vehicle Agency (DVA) in Northern Ireland, of any disability which may cause a danger to the public if they were to drive.

The DVLA produces the At a glance guide to the current medical standards of fitness to drive for medical practitioners that is easy to access online. The booklet is designed to help doctors advise their patients whether or not they should inform the DVLA of their medical condition.

However, the DVLA states that this booklet is only guidance and, where appropriate, the specific medical factors of each case will be considered before an individual licensing decision is reached.

The guidance covers group 1, which is a licence for driving cars and motorcycles; and group 2, which includes lorries and buses. The medical standards for group 2 drivers are higher, due to the size and weight of the vehicle and because the driver may spend longer at the wheel.

Upper age limit
There is no upper age limit to driving. A group 1 licence can be issued from age 17 years (16 years if disabled) and is valid until 70 years. From the age of 70 years this is renewed every three years with a medical self-declaration by the applicant.

A group 2 licence is normally issued at age 21 years and is valid until 45 years. From then on it is renewable every five years to 65 years and from then it is renewable annually. Renewal requests must be submitted with a completed medical application form.

Driving after surgery
In the case of surgery, the DVLA does not need to be notified unless the condition is likely to affect safe driving for longer than three months after the date of surgery.

However, there are neurological and cardiovascular exceptions. The DVLA advises that licence holders wishing to drive after surgery should establish with their doctor when it is safe to do so, taking into account recovery from the procedure and any anaesthetic, whether there is any distracting pain or impairment due to analgesia and whether there are any physical restrictions due to the surgery or comorbidities.

The driver needs to be able to demonstrate that they are in control of the vehicle at all times and they should check their insurance policy.

Conditions
The At a glance booklet lists all conditions that should be reported to the DVLA. Some of the key conditions most likely to be seen in general practice are listed below:

Neurology

  • Epilepsy and withdrawal of medication
  • Unexplained syncope with risk of recurrence
  • Possible seizure
  • Chronic neurological disease such as MS, Parkinson's disease or motor neurone disease
  • Meniere's disease
  • Stroke and TIA
  • Tumours and their treatment
  • Significant head injury/chronic subdural haematoma
  • Meningitis/encephalitis/intracerebral abscess

Cardiology

  • Angina
  • Acute coronary syndrome
  • Percutaneous coronary intervention
  • CABG
  • Arrhythmia
  • Pacemaker implant
  • Implantable cardioverter-defibrillator
  • Thoracic and abdominal aneurysms
  • Hypertension (group 2 restrictions)

Diabetes mellitus

  • Complications - hypoglycaemia, eyesight and renal problems, peripheral neuropathy

Psychiatry

  • Anxiety or depression with memory or concentration problems, agitation, behavioural disturbance or suicidal thoughts
  • Acute psychotic disorder
  • Hypomania/mania
  • Chronic schizophrenia and chronic psychoses
  • Dementia
  • Learning disability (depending on severity)

Drug and alcohol misuse

  • Persistent use or dependency on cannabis, amphetamines, ecstasy, hallucinogens, heroin, morphine, methadone (if misused) or cocaine.

Visual disorders

  • Poor acuity
  • Cataract
  • Visual field defects
  • Diplopia

Others

  • Chronic renal failure
  • Sleep disorders
  • Cough syncope
  • Cancers

Dementia
There is no simple marker to assess the degree of impairment of cognitive function in early dementia, post-stroke and post-head injury, although the DVLA suggests that the ability to manage day-to-day living satisfactorily is a possible marker.

The DVLA advises the patient arranges an in-car assessment on the road, to ensure there are no features which would pose a danger on the road and that reaction time, concentration and confidence are adequate.

The patient can arrange an in-car assessment with the Forum of Disabled Drivers' Assessment Centre.

When to inform the DVLA
The GMC has published supplementary guidance for reporting concerns about patients to the DVLA.

Confidentiality is central to trust between doctors and patients but information can be disclosed if it is required by law, if the patient consents or if it is justified where a failure to disclose may expose others to a risk of serious harm.

You should explain to the patient their condition may affect their ability to drive (if the patient cannot understand this advice because of dementia you should inform the DVLA immediately yourself) and that they have a legal duty to inform the DVLA about their condition.

If the patient disagrees with your diagnosis or that it affects their ability to drive you should try to persuade them to stop and emphasise that you have a legal duty to inform the DVLA.

If they do not consent, suggest that they should get a second opinion but advise them not to drive in the meantime.

If they continue to drive you should write to the patient to inform them of your decision to disclose personal information, inform the DVLA and then inform the patient in writing that a disclosure has been made.

  • Dr Carter is a locum GP in Lancashire and Yorkshire

This topic falls under section 3.3 of the RCGP curriculum 'Clinical Ethics and Values-Based Practice'

Learning points

1. Make sure that you are familiar with the DVLA's At a glance booklet so you know what conditions are listed.

2. If you are not sure whether a patient may be unfit to drive contact the medical advisor at the DVLA.

3. If you think you may need to break confidentiality discuss it with a senior colleague and contact your medical defence organisation

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