Key Facts

Fitness to drive is a common clinical scenario in primary care. The legal obligation to notify the DVLA rests with the patient, but doctors have a professional duty to inform patients and, if necessary, to breach confidentiality to protect public safety.

Legal Framework

• Road Traffic Act 1988: patients must notify DVLA of prescribed (long-term) and relevant (temporary) disabilities
• Motor Vehicles (Driving Licences) Regulations 1999: medical standards for driving
• GMC guidance: doctors should advise patients, make reasonable efforts to persuade, and may disclose to DVLA if patient refuses

Licence Groups

• Group 1: ordinary car and motorcycle licence (most drivers)
• Group 2: large goods vehicle (LGV/HGV) and passenger-carrying vehicle (PCV/bus) — significantly stricter medical standards due to higher risk

GP Role

• Advise patients about conditions affecting driving
• Inform patients of their duty to notify DVLA
• Complete DVLA medical questionnaires when requested
• Document advice given in medical records
• If patient refuses to notify: may disclose to DVLA (last resort)

Common Conditions Affecting Driving

Neurological:

• Epilepsy: Group 1 — 12 months seizure-free; Group 2 — 10 years seizure-free off medication
• Stroke/TIA: Group 1 — 1 month; Group 2 — 12 months
• Sleep disorders: excessive daytime somnolence must be controlled

Cardiovascular:

• MI: Group 1 — 1 week if successful PCI/no complications; 4 weeks otherwise; Group 2 — 6 weeks
• Arrhythmia (causing incapacity): Group 1 — until controlled; Group 2 — stricter
• Pacemaker insertion: Group 1 — 1 week; Group 2 — 6 weeks
• ICD: Group 1 — 6 months (if for secondary prevention), 1 month (if prophylactic); Group 2 — permanently barred

Diabetes:

• Insulin-treated: must notify DVLA; Group 1 — can drive if meets criteria (hypo awareness, monitoring); Group 2 — very strict (requires specialist assessment)
• Hypoglycaemia requiring assistance: Group 1 — stop driving, notify DVLA; resume when meets criteria

Visual:

• Must be able to read a number plate at 20 metres (20.5m for post-September 2001 plates)
• Acuity ≥6/12 (Snellen) with both eyes open (Group 1); ≥6/7.5 (Group 2)
• Visual field: ≥120° horizontal; no significant defect within central 20°

Psychiatric/Substance Misuse:

• Severe depression, psychosis: must not drive if condition impairs driving ability
• Alcohol/drug misuse: specific periods of abstinence/stability required
• Benzodiazepine dependence: must not drive during withdrawal; stability required

When to Advise Patients

• New diagnosis of notifiable condition
• Change in condition (e.g. new seizure, visual deterioration)
• Starting medication that may affect driving (sedating drugs)
• Post-operative (e.g. post-anaesthetic, post-eye surgery)

Assessment

• Clinical assessment of condition severity and stability
• Visual assessment: visual acuity, visual fields (confrontation or formal perimetry)
• Cognitive assessment where relevant (dementia, brain injury)
• Fitness to drive assessment (occupational therapy, specialist driving assessment)

DVLA Medical Questionnaires

• Completed at DVLA's request (with patient's consent)
• Provide factual medical information
• DVLA makes the licensing decision (not the doctor)
• Doctor does not need to decide fitness to drive — only to provide medical information

Step-by-Step Approach

1. Diagnose the condition and assess impact on driving
2. Advise the patient that the condition may affect their driving
3. Inform the patient of their legal duty to notify DVLA
4. Document the advice given in the medical record
5. If patient agrees: support their notification to DVLA
6. If patient refuses: a. Explain the risks to themselves and others b. Advise them not to drive c. Make every reasonable effort to persuade d. If still refuses: inform the patient you will notify DVLA e. Disclose minimum necessary information to DVLA medical adviser f. Document all steps taken

Referral Criteria

• Complex fitness to drive assessments: occupational therapy driving assessment, specialist centres
• DVLA medical adviser: for clinical queries about driving restrictions
• Legal advice: if patient threatens legal action for disclosure

• Appropriate restriction of driving reduces road traffic accidents and saves lives
• DVLA revokes approximately 50,000 licences per year on medical grounds
• Most conditions have defined periods after which driving can resume
• Patient compliance with notification is variable; estimated 50% under-reporting
• Failure to notify DVLA is a criminal offence; driving without medical clearance invalidates insurance

DVLA Notification — Doctor's Responsibilities (GMC Guidance)

Selected Driving Restrictions Summary