The 'Assessing fitness to drive: guide for medical professionals' is produced by the Driver and Vehicle Licensing Agency (DLVA) and is a guide for medical professionals to help them with enquiries from the public about driving with various conditions.
UK driver licensing
Licensing and licence groups
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. This is because of the size and weight of the vehicle and the length of time an occupational driver typically spends at the wheel.
Drivers who were awarded a Group 1 category B (motor car) licence before 1 January 1997 have additional entitlement to categories C1 (medium-sized lorries, 3.5t to 7.5t) and D1 (minibuses, 9 to 16 seats, not for hire or reward). Drivers with this entitlement retain it only until their licence expires or it is revoked for medical reasons.
Under certain circumstances, volunteer drivers may drive a minibus of up to 16 seats without category D1 entitlement. The DVLA outlines the rules for such circumstances on the GOV.UK website (see Driving a minibus).
Age limits for licensing
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. (A person can’t apply for PIP until their 16th birthday.)
Group 2 entitlement to drive lorries (category C) or buses (category D) is normally given to people over 21 and is valid until the age of 45. Group 2 licences issued since 19th January 2013 are valid for a maximum of five years. Group 2 licences must be renewed every 5 years or at age 45 whichever is the earlier until the age of 65 when they are renewed annually without an upper age limit. Shorter licences may be issued for medical reasons.
There are exceptions, such as driving in the armed forces, and people of a minimum age of 18 can drive lorries and buses after gaining, or training towards, the Driver Certificate of Professional Competence (CPC).
All initial Group 2 licence applications require a medical assessment by a registered medical practitioner (recorded on the D4 form). The same assessment is required again at 45 years of age and on any subsequent reapplication.
Police, fire, ambulance and health service driver licensing
The same medical standards apply for drivers of police, fire, coastguard, ambulance and health service vehicles as they do for all drivers holding Group 1 and 2 licences. Any responsibility for determining higher medical standards, over and above these licensing requirements, rests with the individual force, service or other relevant body.
Note, however, that the Secretary of State’s Honorary Medical Advisory Panel on Diabetes and Driving has recommended that drivers with insulin-treated diabetes do not drive emergency vehicles. This takes account of the difficulties for an individual, regardless of whether they may appear to have exemplary glycaemic control, in adhering to the monitoring processes required when driving in response to an emergency.
Responsibility for determining any higher standards and medical requirements for taxi drivers, over and above the driver licensing requirements, rests with Transport for London in the Metropolitan area, or the Local Authority in all other areas.
Advice on best practice for local authorities issuing taxi licences is given by the booklet, ‘Fitness to drive: a guide for health professionals’, published in 2006 by The Royal Society of Medicine (RSM) on behalf of the Department for Transport (ISBN reference 9781853156519).
This guide for local authorities recommends that taxi drivers should meet the same medical standards that Group 2 bus and lorry drivers must meet under the DVLA’s requirements.
Interpretation of EU and UK legislation
The advice of the Honorary Medical Advisory Panels on the interpretation of EU and UK legislation and its appropriate application is made within the context of driver licensing.
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
These figures, while originally defined by older studies, have since been revalidated by more recent risk-of-harm calculations.
DVLA notification by drivers or healthcare professionals
Applicants and 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 (except some short-term conditions, as set out in this guide)
- respond fully and accurately to any requests for information from either the DVLA or healthcare professionals
- comply with the requirements of the issued licence, including any periodic medical reviews indicated by the DVLA.
They should also adhere, with ongoing consideration of fitness to drive, to prescribed medical treatment, and to monitor and manage the condition and any adaptations.
Doctors and other healthcare professionals should:
- advise the individual on the impact of their medical condition for safe driving ability
- advise the individual on their legal requirement to notify the DVLA of any relevant condition
- treat, manage and monitor the individual’s condition with ongoing consideration of their fitness to drive
- notify the DVLA when fitness to drive requires notification but an individual cannot or will not notify the DVLA themselves
Of course, this last obligation on professionals may pose a challenge to issues of consent and the relationship between patient and healthcare professional. The GMC and The College of Optometrists offer guidance on this which is summarised below. (Note that the GMC is currently considering updating this guidance.)
In law it is the duty of the licence holder or applicant to notify the DVLA of any medical condition that may affect safe driving. This notification by people with licences issued by the DVLA (because they live in England, Scotland or Wales) may be done via GOV.UK – see Medical conditions, disabilities and driving.
For people with licences issued by the Driver and Vehicle Agency in Northern Ireland, the options for direct notification are given on the NI Direct page: How to tell DVA about a medical condition.
Circumstances may arise in which a person cannot or will not notify the DVLA. It may be necessary for a doctor, optometrist or other healthcare professional to consider notifying the DVLA under such circumstances if there is concern for road safety, which would be for both the individual and the wider public.
The General Medical Council and The College of Optometrists offer clear guidance about notifying the DVLA when the person cannot or will not exercise their own legal duty to do so.
The GMC guidelines (reproduced with permission) state:
- The driver is legally responsible for informing the DVLA about such a condition or treatment. However, if a patient has such a condition, you should explain to the patient:
- That the condition may affect their ability to drive (if the patient is incapable of understanding this advice, for example because of dementia, you should inform the DVLA immediately) and,
- That they have a legal duty to inform the DVLA about the condition.
- If a patient refuses to accept the diagnosis, or the effect of the condition on their ability to drive, you can suggest that they seek a second opinion, and help arrange for them to do so. You should advise the patient not to drive in the meantime.
- If a patient continues to drive when they may not be fit to do so, you should make every reasonable effort to persuade them to stop. As long as the patient agrees, you may discuss your concerns with their relatives, friends or carers.
- If you do not manage to persuade the patient to stop driving, or you discover that they are continuing to drive against your advice, you should contact the DVLA immediately and disclose any relevant medical information, in confidence, to the medical adviser.
- Before contacting the DVLA, you should try to inform the patient of your decision to disclose personal information. You should also inform the patient in writing once you have done so.
See the full guidance at the GMC website, Confidentiality: reporting concerns about patients to the DVLA or the DVA.
The College of Optometrists offers similar guidance, available in full at its website under the confidentiality section of its Guidance for Professional Practice (use the subsection on ‘disclosing information about adults without their consent’).
This guidance includes the following (reproduced with permission of The College of Optometrists):
(C73) If you think the patient may be engaging in an activity where they pose a very real risk of danger to the public or themselves, such as the patient driving when they are not fit to drive, but you are not sure whether you should act, ask yourself:
- what might the outcome be in the short or longer term if I do not raise my concern?
- how could I justify why I did not raise the concern?
(C74) If you decide to proceed, you should:
- first advise the patient that they are unfit to engage in the activity in question and give the reasons
- advise the patient to tell the appropriate authority
- put your advice in writing to the patient, if appropriate
- keep a copy of any correspondence to the patient on the patient record
Notification can be provided by healthcare professionals in the above circumstances, in confidence:
Telephone: 01792 782337
Medical Business Support
How the DVLA responds to notification and applies the medical standards
Once the DVLA is notified of a medical condition and obtains consent, it will make medical enquiries as required.
The Secretary of State (in practice, the DVLA) is unable to make a licensing decision until all the relevant medical information is available and has been considered. Exceptions to this do exist, specifically the DVLA’s ability to revoke a licence immediately in the interests of road safety and without detailed enquiry if individual case circumstances dictate this.
The DVLA’s medical enquiries procedure is generally a two-stage process:
- Information on the medical condition is sought from the licence holder or applicant, either by paper questionnaire or online
- Information is sought from relevant healthcare professionals, either by questionnaire or provision of medical notes.
In some circumstances the DVLA will require independent review by a DVLA-appointed doctor or optician/optometrist. Depending on individual circumstances, a licence applicant may also require a driving assessment and/or appraisal.
Driving during medical enquiries
The time taken to obtain all necessary reports can be lengthy but a licence holder normally retains entitlement to drive under Section 88 of the Road Traffic Act 1988. However, a driver whose last licence was revoked or refused because of a medical condition or is a High Risk Offender re-applying after a drink/drive disqualification from 1 June 2013 would not, however, be eligible to drive until they are issued with a new licence.
The driver may be covered to drive but this carries implications for road safety in that the licence holder may continue to drive with a medical condition that, on completion of the DVLA’s enquiries, may ultimately result in licence withdrawal.
It is for the patient to assure themself that they are fit to drive. Medical professionals asked for an opinion about a patient’s fitness to drive in these circumstances should explain the likely outcome by reference to this guide. The final decision in relation to driver licensing will, however, rest with the DVLA.
By reference to the DVLA’s guidance, the doctor in charge of an individual’s care should be able to advise the driver whether or not it is safe for them to continue to drive during this period.
Patients must be reminded that if they choose to ignore medical advice to stop driving this may affect their insurance cover. Doctors are advised to formally and clearly document the advice given.
The DVLA is solely reliant on doctors and other healthcare professionals for the provision of medical information. To make timely licensing decisions that impact on the safety of the individual and the public, the DVLA needs information to be provided as quickly as possible.
When the DVLA holds all relevant information, a decision can then be made as to whether or not the driver or applicant satisfies the national medical guidelines and the requirements of the law. A licence is accordingly issued or refused/revoked.
Outcome of medical enquiries
The DVLA does not routinely tell doctors of the outcome of a medical enquiry. Drivers are always informed of the outcome, either by being issued a licence or by notification of a refusal or revocation.
For cases in which the driver may not have the insight and/or memory function to abide by the refusal or revocation of their licence – for example, in cognitive impairment, dementia or a mental health condition – the DVLA would usually send a decision letter to the GP.
When a notification is received from a doctor in accordance with the GMC guidelines, unless relevant to one of these conditions affecting mental capacity, the DVLA will send an acknowledgement letter only to the GP, to confirm receipt of the original notification.
Medical notification form for use by healthcare professionals
The medical notification form for use when patients cannot or will not notify the DVLA themselves is available, for use by healthcare professionals only, on GOV.UK. This form is only for patients living in England, Scotland or Wales who hold a driving licence issued by the DVLA.
The completed form should be returned to:
Medical Business Support
For patients living in Northern Ireland who cannot or will not self-notify, please use these contact details:
Telephone: 0300 200 7861
Drivers Medical Section
Driver and Vehicle Agency
Please fill in all parts of the DVLA’s medical notification form in relation to the medical condition of your patient. Parts A and B are for your patient’s and your own details, including your signed and dated declaration that all details are correct to the best of your knowledge.
Part C of the form should be completed in all fields and providing as much detail as possible regarding your patient’s medical condition. You may send clinic letters with this notification, to help provide details of your patient’s medical condition or if you think it will aid the licensing decision.
Please note, your patient can request copies of any medical documents held at the DVLA unless you specify in writing that releasing this information could cause serious harm to your patient.
The DVLA cannot be responsible for the payment of any fee associated with notification.
Obtaining advice from the DVLA on fitness to drive
Contacting the DVLA's medical advisers
Doctors and other healthcare professionals are always welcome to write, fax, email or speak (by telephone between 10.30am and 1pm from Monday to Friday) to one of the DVLA’s medical advisers.
Advice may be sought about a particular driver identified by a unique reference number, or about fitness to drive in general.
If the telephone service is busy, you will be able to leave a message for one of the medical advisers to call back.
The contact details for such enquiries in England, Scotland and Wales are:
Telephone: 01792 782337
Fax: 01792 761104
The Medical Adviser
Drivers Medical Group
Please note that this service is for medical professionals only.
The contact details for enquiries in Northern Ireland are:
Telephone: 0300 200 7861
Drivers Medical Section
Driver and Vehicle Agency
Seat belt use and exemption
The law makes it compulsory for car occupants to wear seatbelts where fixed. Exemption on medical grounds requires a valid exemption certificate to confirm that, in a medical practitioner’s view, exemption is justified. Exemption will require careful consideration in view of extensive evidence for the safety implications of seatbelts in reducing casualty rates.
View guidance leaflet Medical exemption from compulsory seat belt wearing.
© Crown copyright. Reproduced under the terms of the Open Government Licence.