The GMC’s new guidance on confidentiality comes into effect on 25 April 2017. In addition to revising the general guidance, the GMC has also updated the specific principles on a patient’s fitness to drive and reporting concerns to the DVLA or DVA.
The GMC clearly states the steps that a doctor should take if they believe a patient may pose a risk to others by continuing to drive.
1. Assess the patient’s fitness to drive against the required standard
Doctors need to be aware that a patient’s ability to drive can be affected by a condition or diagnosis, and also by a treatment that they may be receiving or about to receive. This could be an intervention or a medication.
When assessing a patient’s fitness to drive doctors are advised that they should refer to the DVLA’s guidance Assessing fitness to drive - a guide for medical professionals and if necessary take advice from an experienced colleague, or a medical adviser at the DVLA or DVA.
The guidance 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.
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.
2. Tell the patient to inform the DVLA
Your responsibility is to explain to the patient that they have a medical condition or will be receiving treatment 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 Bear in mind that the decision on whether the patient’s licence will be withdrawn rests with the DVLA or DVA and not the doctor.
The revised guidance also goes on to explain that you should tell the patient that you may be obliged to disclose relevant medical information to the DVLA or DVA if they continue to drive against your advice. You should also document what advice you have given to the patient in their medical record.
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. 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 does not have the capacity to understand your advice, for example because of dementia, you should inform the DVLA or DVA straight away.
4. Consider the potential risk
If the patient continues to drive contrary to your advice you need to consider whether their refusal to stop driving leaves others exposed to a risk of death or serious harm. If you believe this to be the case you should then contact the DVLA or DVA promptly. 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 if the patient objects to the disclosure you should consider any reasons they give for objecting. If disclosure remains appropriate then 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 to ensure you follow the GMC and DVLA’s guidance and we recommend that you consult us at an early stage.
What else to consider
The crash of Germanwings flight 9525 in March 2015 raised the public’s concern about the fitness of individuals taking charge of other modes of transport.
It is important to note, that the guidance clearly indicates that the principles contained apply equally to drivers and pilots of other kinds of regulated transport such as trains, boats and planes. They also contain helpful contact details for the relevant agencies and authorities where further advice may be obtained.
- Dr Nicola Lennard is medico-legal adviser at the MDU
This is an updated version of an article that was first published in March 2016.