In December 2014 a bin lorry careered out of control in a busy shopping street in Glasgow leading to the tragic death of six people. The recent fatal accident inquiry into the incident has led to increased concern among doctors about their responsibility to disclose information about their patients to the DVLA.
The heightened awareness of both the public and healthcare professionals has led to more doctors contacting the MDU for advice about the circumstances under which they can disclose patient information to the DVLA (or DVA in Northern Ireland).
We deal with many calls on our advice line about this topic and last year we also helped 45 members respond to complaints and other medico-legal issues related to DVLA disclosures. This compares to just 26 cases in 2014. Some complaints had been escalated to the GMC.
GPs may feel anxious about disclosing information to the DVLA or DVA but following a stepwise approach can allow you to deal with these difficult discussions more confidently.
1. Tell the patient to inform the DVLA
Your responsibility is to explain to the patient that they have a medical condition that may affect their ability to drive and that they have a legal obligation to inform the DVLA or DVA, and to stop driving.
It is the driver’s legal responsibility to inform the authorities of this advice and it is a criminal offence for the driver to fail to do so. Bear in mind that the decision on whether the patient’s licence will be withdrawn rests with the DVLA or DVA and not the doctor.
2. Assess the medical condition against the required standard
For certain medical conditions this may be relatively straightforward, but others are not so black and white. Be aware that different standards apply to professional drivers, such as HGV drivers and bus drivers, and this needs to be taken into consideration when coming to a decision.
If in doubt, check the DVLA’s recently revised guidance for medical professionals which explains the current standards for medical fitness on a wide variety of medical conditions and the different classes of driver. It also provides advice about more complex cases, such as patients who suffer from multiple conditions which alone might not reach the threshold for reporting but when combined together cause concern.
If you remain uncertain whether the condition does reach the threshold you can discuss the case anonymously with a DVLA medical adviser.
3. Try to persuade the patient to stop driving
The potential loss of their independence or financial income can mean that some patients do not accept medical advice to stop driving and inform the DVLA or DVA and it is no surprise that this is a frequent cause for complaint.
You must give clear advice to the patient that they must stop driving. If they disagree with you and believe that they are fit to drive then you can suggest they seek a second opinion. However you should make it clear to the patient that they must refrain from driving while the second opinion is obtained.
If the patient consents, you can enlist the help of a relative to help to persuade them. If however the patient does not have the capacity to understand your advice you should inform the DVLA or DVA straight away. Equally if the patient continues to drive contrary to your advice then the DVLA or DVA should be informed immediately.
4. Only disclose the minimum information
You need only disclose the minimum amount of information necessary so that the DVLA or DVA can identify the patient. Ideally you should inform the patient of your intention to disclose information prior to doing so and you should write to the patient afterwards to inform them what information you have disclosed and to whom.
5. Keep detailed records
It is not uncommon for patients to complain when a disclosure has been made and in some cases these complaints have been referred to the GMC.
If this happens, having clear and comprehensive records about what you discussed with the patient before the disclosure and whether you warned them prior to disclosing the information, can help you provide a robust response and demonstrate that you have followed the proper process.
Your medical defence organisation can help you to ensure you follow the GMC and DVLA’s guidance and we recommend that you consult us at an early stage.
- Dr Nicola Lennard is medico-legal adviser at the MDU