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Fitness to drive

Dr Rajesh Varma

Advice for medical professionals to follow when assessing a patient's fitness to drive. DVLA September 2019

The UK medical standards for driver licensing refer to Group 1 and Group 2 licence holders

■ Group 1 includes cars and motorcycles 

■ Group 2 includes large lorries (category C) and buses (category D). 

In most cases, the medical standards for Group 2 drivers are substantially higher than for Group 1 drivers. 

Age limits for licensing 

Group 1 
Licences are normally valid until 70 years of age (the ’til 70 licence) unless restricted to a shorter duration for medical reasons. 
There is no upper age limit to licensing, but after 70 renewal is required every 3 years. 
A person in receipt of the mobility component of Personal Independence Payment can hold a driving licence from 16 years of age

Sudden disabling events 

Anyone with a medical condition likely to cause a sudden disabling event at the wheel, or who is unable to control their vehicle safely for any other reason, must not drive. 

The DVLA defines the risk of a sudden disabling event as: 

■ 20% likelihood of an event in 1 year for Group 1 licensing 

■ 2% likelihood of an event in 1 year Group 2 licensing. 

DVLA notification by drivers or healthcare professionals

Licence holders have a legal duty to notify the DVLA of any injury or illness that would have a likely impact on safe driving ability

Doctors should:

  1. Advise the individual on the impact of their medical condition for safe driving ability

  2. Advise the individual on their legal requirement to notify the DVLA of any relevant condition

  3. Tell the patient that you may be obliged to disclose relevant medical information about them, in confidence, to the DVLA if they continue to drive when they are not fit to do so.

  4. Notify the DVLA when fitness to drive requires notification but an individual cannot (for example, lacks understanding due to dementia) or will not notify the DVLA themselves.

  5. If you decide to contact the DVLA, you should ask for a patient’s consent to disclose information for the protection of others, tell your patient in writing once you have done so, and make a note on the patient’s record.

  6. If you become aware that a patient is continuing to drive when they may not be fit to do so, you should make every reasonable effort to persuade them to stop. If you do not manage to persuade the patient to stop driving, you should contact the DVLA promptly.

Legal basis

Doctors owe a duty of confidentiality to their patients, but they also have a wider duty to protect and promote the health of patients and the public. If it is not practicable to seek consent, and in exceptional cases where a patient has refused consent, disclosing personal information may be justified in the public interest if failure to do so may expose others to a risk of death or serious harm. The benefits to an individual or to society of the disclosure must outweigh both the patient’s and the public interest in keeping the information confidential.

See the full guidance on the GMC website: Confidentiality: patients’ fitness to drive and reporting concerns to the DVLA or DVA.

This is an abridged version of the medical advice

A selection of key conditions that require notification to the DVLA

  • Epilepsy

  • Unexplained syncope or blackout

  • Neurological or cognitive deficit persisting 1 month after stroke

  • Multiple transient ischaemic attacks

  • Pacemaker implant or Implantable cardioverter defibrillator

  • Aortic aneurysm (thoracic or abdominal) >6cm diameter

  • Severe heart failure NYHA Class IV

  • Insulin-treated diabetes

  • Impaired awareness of hypoglycaemia

  • Acute/chronic psychotic disorders 

  • Dementia

  • Severe Learning Disability

  • Parkinson's disease

  • Any severe psychiatric illness

  • Drug or alcohol misuse dependence

  • Visual acuity and field of vision not meeting minimum standard for driver

Neurological conditions

  1. Epilepsy or multiple unprovoked seizures. Must not drive and must notify the DVLA. Driving must cease for 12 months from the date of the seizure.

  2. First unprovoked epileptic seizure/isolated seizure. Must not drive and must notify the DVLA. Driving must cease for 6 months from the date of the seizure OR or for 12 months if there is an underlying causative factor that may increase risk.

  3. Unexplained syncope while standing or sitting without reliable prodrome. Must not drive and must notify the DVLA.

  4. Stroke and central venous thrombosis. Driving may resume after 1 month if there has been satisfactory clinical recovery. DVLA does not need to be notified.
    However,     notify DVLA if there is residual neurological deficit 1 month after the episode 

  5. Single transient ischaemic attack. Must not drive for 1 month but need not notify the DVLA.

  6. Multiple transient ischaemic attacks. Must not drive and must notify the DVLA.

Cardiovascular disorders

  1. Angina. Must not drive if symptoms occur at rest, with emotion or at the wheel. Driving may resume after satisfactory symptom control. Need not notify the DVLA.

  2. Acute coronary syndromes (ACS). Driving may resume 1 week after ACS if successful coronary intervention (PCI). Must not drive but need not notify the DVLA.  

  3. Elective percutaneous coronary intervention (PCI). Must not drive for at least 1 week but need not notify the DVLA. 

  4. Coronary artery bypass graft (CABG). Must not drive for at leat 4 weeks but need not notify the DVLA. 

  5. Arrhythmias. Must not drive if arrhythmia has caused or is likely to cause incapacity. Driving may resume without DVLA notification if arrhythmia is controlled for at least 4 weeks.

  6. Pacemaker implant. Must not drive for at least 1 week and must notify the DVLA. 

  7. Implantable cardioverter defibrillator (ICD). Must not drive and must notify the DVLA. 

  8. Aortic aneurysm (thoracic or abdominal). Must notify the DVLA if >6cm diameter. Must not drive if >6.5cm diameter 

  9. Severe Heart failure. NYHA Class IV. Must not drive and must notify the DVLA. May drive if NYHA class 1, class II, class III

Diabetes

Insulin-treated diabetes

Must meet the criteria to drive and must notify the DVLA.

All the following criteria must be met for the DVLA to license the person with insulin-treated diabetes for 1, 2 or 3 years:

  • adequate awareness of hypoglycaemia

  • no more than 1 episode of severe hypoglycaemia while awake in the preceding 12 months

  • practises appropriate glucose monitoring (glucose testing no more than 2 hours before the start of the first journey and every 2 hours after driving has started)

  • meets the visual standards

Impaired awareness of hypoglycaemia – ‘hypoglycaemia unawareness’ . Must not drive and must notify the DVLA. 

Diabetes treated by medication other than insulin (Including sulphonylureas and glinides)

May drive and need not notify the DVLA, provided no more than 1 episode of severe hypoglycaemia while awake in the last 12 months 

Psychiatric disorders

Acute/chronic psychotic disorders Cease driving unless patient has had stable behaviour for ≥3 months. Must notify the DVLA. 

Dementia. May be able to drive but must notify the DVLA. 

Severe Learning Disability. Must not drive and must notify the DVLA. 

Parkinson's disease. May be licensed if driving performance is not impaired. Must notify the DVLA. 

Drug or alcohol misuse or dependence

Dependence confirmed by medical enquiry. Must not drive and must notify the DVLA. 

Licence withheld until patient has been free of problems for:
– ≥6 months (persistent alcohol misuse; misuse of cannabis, amphetamines, ecstasy, ketamine, psychoactive drugs) or
– ≥1 year (alcohol dependency; misuse of heroin, morphine, methadone, cocaine, methamphetamine, benzodiazepines)

Visual Disorders

Minimum eyesight standards – all drivers 

  1. Read the vehicle number plate from a distance of 20 metres

  2. Visual acuity must be at least Snellen 6/12 with both eyes open or in the only eye if monocular. 

  3. The minimum field of vision at least 120° on the horizontal

Any driver unable to meet these standards must not drive and must notify the DVLA.

Visual defects caused by bilateral glaucoma, bilateral retinopathy, retinitis pigmentosa: must notify DVLA
Diplopia, nyctalopia (night-blindness), blepharospasm: must not drive and must notify DVLA

Colour blindness: may drive and need not notify DVLA

Monocular vision Must not drive and may need to notify the DVLA (they must meet the same visual acuity and visual field standards as binocular drivers)