Guest blog by Dr Nick Jenkins, Senior DVLA Doctor
Around 48 million people hold a GB driving licence and individuals depend greatly upon their ability to drive for their employment, their day to day lives and socially.
There can, however, be confusion amongst clinicians as to the respective roles and responsibilities of Healthcare Professionals (HCPs) and of the Driver and Vehicle Licensing Agency (DVLA) when considering whether a patient’s medical conditions may have an impact on road safety.
The Road Traffic Act (1988) places the legal responsibility on the licence holder or driving licence applicant to disclose to the Secretary of State (in practice the DVLA) any medical condition that may affect driving safety. To help drivers meet this obligation we have developed an easy to navigate, online A-Z guide of medical conditions that can be found at: www.gov.uk/health-conditions-and-driving
The DVLA is an executive agency of the Department for Transport and is responsible for licensing those who have notifiable medical conditions. The DVLA, where I am the Senior Doctor, is specifically responsible for assessing whether an individual’s medical condition meets the appropriate standards for driving. In doing so we contribute to the safety of all road users.
The ongoing management of a person’s medical condition involves a partnership between the individual and their clinician. Consideration of the impact of an individual’s medical condition upon their ability to drive safely, and thus safeguarding both them and the wider general public, requires collaboration between the individual, their clinician and ourselves.
The DVLA received around 750,000 notifications of medical conditions in 2018. Of those, 170,000 represented the first notification of a condition to us, whilst the remainder represented the renewals of short-term licences issued for an already-declared medical condition. Approximately 4% of licence holders have told us about a medical condition, however, we do acknowledge that some people do fail to disclose their medical condition to us. The reasons for this are likely to be multi-factorial, but fear of losing their licence as a consequence of the disclosure may be a significant factor. For others, it may simply be that they do not understand the potential of their medical condition to impact on their ability to drive safely.
Health professionals can be in a unique position in knowing whether their patient has a condition that may affect driving. They play an important part in the medical notification process by advising their patients of the implications of their condition, the effect of any treatment or medication that they are receiving, and whether they need to tell the DVLA.
Clinicians may also reassure their patients that the vast majority of individuals will retain their driving licence following disclosure, either as a full-term licence or a short-term (medical review) licence.
We may issue licences of shorter duration (between one and five years) to people whose medical condition is considered to be either progressive (e.g. dementia), where we need to assess the ongoing stability of that condition or to consider the risk of recurrence of an episode being below a certain threshold. For others, adaptations to the vehicle that they drive may extend the time that they can continue to drive safely. Ideally the patient and their clinician will have discussed other means of transport/maintaining independence long before the time when a condition has progressed to a stage which is incompatible with safe driving.
Information to guide a clinician as to their patient’s ability to meet the required medical standard of fitness to drive is available in the “Assessing Fitness to Drive – a guide for medical professionals” document, which is available online at: www.gov.uk/guidance/assessing-fitness-to-drive-a-guide-for-medical-professionals
As an agency we receive advice regarding the appropriate medical standards from the Secretary of State for Transport’s Honorary Medical Advisory Panels which meet twice a year, and the published guidance is regularly updated as a result of that advice. Clinicians are able to sign up for email alerts to such updates.
We work in partnership with patient groups and organisations in order to increase the public’s awareness of the medical standards. We also work closely with professional and regulatory bodies (e.g. General Medical Council (GMC), General Optical Council (GOC), Medical Royal Colleges) to help maintain awareness of the standards amongst the diverse group of health care professionals (HCPs) caring for patients with conditions which might impact upon driving.
There have been high profile cases where there has been a loss of life or life changing injury as a result of a medical episode and the driver had failed to notify the agency or withheld their medical history from the other health professionals involved. Fatal accident enquiries, inquests or the media often focus upon the involvement and responsibilities of HCPs and their sharing of information with the DVLA. Following one such case the GMC consulted on the issues of confidentiality and disclosure - reviewing its guidance on dealing with medical conditions, driver safety and liaising with the DVLA. Its revised guidance Confidentiality: good practice in handling patient information and the accompanying explanatory guidance Confidentiality: patients’ fitness to drive and reporting concerns to the DVLA or DVA both came into effect in April 2017. These documents clearly describe the roles and responsibilities of doctors with regard to road safety. The guidance resulted in an increase in notifications from doctors and also from other HCPs to the DVLA. Similar guidelines have also been issued by the College of Optometrists. The Agency has also more recently worked with the GOC to develop similar guidance and their consultation regarding that guidance was launched in March 2019. In the absence of similar guidance from other regulatory bodies many HCPs are choosing to refer to GMC guidance when deciding whether or not to disclose information to the DVLA.
The GB medical standards for driver licensing refer to Group 1 (cars and motorcycles) and Group 2 (lorries and buses). In most cases, the medical standards for Group 2 drivers are stricter than for Group 1 drivers, for example, the vision requirements. There are also stricter standards for those conditions where there may be an underlying risk of a sudden disabling episode. This reflects the size and weight of the vehicles involved and also the length of time an occupational driver typically spends at the wheel.
We appreciate that some employment-related driving involves vehicles categorised as Group 1. Some employers may choose to apply a higher medical standard for their drivers than required for the category of vehicle that they drive. For example, for drivers of emergency vehicles. Drivers of taxis or private hire vehicles are also generally subject to higher medical standards and the responsibility for any additional requirements rests with the relevant local authority or Transport for London. The Group 2 standards provide a good basis for any employer wanting to apply stricter standards for their drivers in the interests of road safety.
In writing this article I hope that I have clarified the various responsibilities of HCPs and of the DVLA in ensuring the safety of drivers and all road users. I hope that any HCP who has a concern regarding their patient’s driving will be encouraged to contact one of the doctors here at DVLA to discuss those concerns confidentially, using either the secure email (medadviser@dvla.gov.uk) or on our “doctor-to-doctor” telephone line (01792-782337 - line is open 10.30am – 1pm Monday-Friday). Like you, our priority is to ensure that your patient is safe to drive - we would like to assist you in ensuring that your patient is able to continue in their driving career for as long as they are safe to do so.