In order to drive a car safely, a person needs to have the motor coordination to turn the wheel and operate the pedals, as well as the neurological fitness to perceive and then react to danger.
The most common reason for collapsing behind the wheel in the UK is a seizure. Cardiac conditions such as arrhythmias and cerebrovascular events can also have devastating effects if they occur while driving.
Questions dealing with fitness to drive assessments are commonly found in MRCGP exam papers. GPs often deal with these issues, and for registrars new to primary care, they can seem daunting.
There are excellent resources available from the Driver Vehicle and Licensing Authority (DVLA). A 50-page booklet giving the driving regulations for specific medical conditions can be found on their website, which can be downloaded and kept as reference.
It contains all the information that you need to inform patients about driving. Medical advisers from the DVLA are also available to speak to doctors over the phone about specific issues. In Northern Ireland driving licences are issued by the Driver and Vehicle Agency (DVANI).
Licences are divided into two categories. Group 1 entitlement covers cars and motorcycles. Group 2 entitlement covers heavy goods vehicles and public service vehicles.
The regulations for Group 2 are much tighter than for Group 1 because there is a higher level of risk associated with the longer hours spent behind the wheel by people who drive for a living.
Assessing the patient
When faced with a patient with a new-onset condition, always ask yourself whether this person should be driving.
This also applies to patients presenting with an exacerbation of a pre-existing condition, as in the case of a patient with previously well-controlled epilepsy who has suffered a seizure.
If it is clear from the guidelines that the patient should stop driving you are obliged to inform them of this, and to ask them to notify the DVLA.
The patient is then legally required to inform the DVLA. It is the DVLA, not the GP, who is legally responsible for deciding whether a person is fit to drive.
Always document your conversations with the patient clearly in the notes.
The DVLA will inform the patient whether or not they can continue driving and, if not, when they can re-apply for their licence. The patient must not drive until this decision is made.
Support for patient and GP
The onset of an illness that affects ability to drive can be devastating for the person concerned and many patients may be upset or angry on being told that they cannot drive.
A patient may disagree with your assessment of their ability to drive. They are entitled to a second opinion, and you should arrange this for them, but they should not drive while waiting for the appointment.
If the patient continues to drive and refuses to inform the DVLA, you should urge them strongly and repeatedly to stop. You may also need to inform a next of kin about the patient's actions.
If these interventions are unsuccessful, the next step is to inform the DVLA that the patient is continuing to drive.
The law allows you to break confidentiality in such cases because of the risks presented by the patient continuing to drive. You should discuss this with the patient before you contact the DVLA and confirm it in writing afterwards.
Limit the information that you give to the DVLA to the minimum necessary for them to investigate the situation.
You should speak to your trainer about this beforehand, and you may wish to speak to your defence organisation if you are unsure at any stage.
A patient may re-apply for their licence at a time set by the DVLA. The DVLA will then make medical enquiries as to the patient's fitness to drive.
They may contact the patient's GP or specialist and ask them to fill in a medical questionnaire or review the patient. Alternatively the DVLA may arrange for the patient to be seen at a local driver assessment centre.
Certain conditions, such as epilepsy, are protected under the Disability Discrimination Act. Further information can be obtained from the National Society for Epilepsy.
A Group 1 licence is normally issued valid up to the age of 70. Patients with certain conditions may be issued shorter licences, which are renewable at times set by the DVLA.
There is no upper age limit for driving, but after the age of 70, a licence renewal is required every three years. This is usually via a medical declaration made by the applicant with medical review if required.
Group 2 licences have more regulations, and in most cases are renewable every five years from the age of 45 and annually from the age of 65.
Dr Croton is a salaried GP in Birmingham
How to assess a person's fitness to drive:
- Always ask about driving and consider whether a patient's condition may affect their ability to drive.
- Keep up to date with the DVLA guidelines.
- Offer support to patients who have to stop driving through this difficult time.
- Know your responsibilities if a patient refuses to stop driving or inform the DVLA or DVANI.
- DVLA medical driving regulations
- Driving and Vehicle Agency in Northern Ireland
- National Society for Epilepsy