Fitness to Drive

oPatientPlus articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.

Ordinary UK driving licences issued by the Driver and Vehicle Licensing Agency (DVLA) are inscribed with: 'You are required by law to inform Drivers Medical Branch, DVLA, Swansea SA99 1AT at once if you have any disability (either physical or medical condition) which is, or may become, likely to affect your fitness as a driver, unless you do not expect it to last more than three months.'

It is the responsibility of the driver to inform the DVLA. It is the responsibility of doctors to advise patients that medical conditions (and drugs) may affect their ability to drive and for which conditions patients should inform the DVLA.

Drivers should also inform their insurance company of any condition disclosed to the DVLA.

This article provides an overview of common conditions, but is not exhaustive. The DVLA's 'At a glance guide to the current medical standards of fitness to drive' is the standard reference text on this subject and is available online at www.gov.uk/driving-medical-conditions.

If in doubt, ask the Drivers Medical Branch or your defence union on ethical matters.

DVLA states that it must be informed if there is:[1]

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New drivers' vision should reach the following standard:
'They should be able to read in good daylight (with the aid of glasses or contact lenses if worn) a registration mark fixed to a motor vehicle and containing letters and figures 79 millimetres high and 50 millimetres wide (the post-September 2001 font) at a distance of 20 metres, or at a distance of 20.5 metres where the characters are 79 millimetres high and 57 millimetres wide (the pre-September 2001 font).'

Driving must cease for at least one week after:

Driving must cease for at least four weeks after:

Driving should cease if:

  • The patient has angina at rest (until symptoms are controlled).
  • A left ventricular assist device is inserted.

DVLA should be notified if:

  • The patient has abdominal aortic aneurysm ≥6 cm diameter. NB: the patient is disqualified if diameter is >6.5 cm.
  • Arrhythmias present (if the patient is incapacitated). Driving is allowed again when the underlying cause is identified and the symptoms have been controlled for four weeks.
  • Left ventricular assist device in situ.

Diabetic drivers are sent a detailed information sheet about their licence and driving by the DVLA.

  • All drivers on insulin must inform the DVLA.
  • In general, it is wise to stop driving for one month after starting insulin, in order to become stable on the treatment.[2]
  • Drivers must demonstrate satisfactory control and must recognise hypoglycaemia.
  • Check that vision conforms to required standard (see 'Vision', above).
  • Advise them to avoid driving if there is hypoglycaemic risk, eg meal delay, or after excess exercise.
  • Patients should not drive if they feel hypoglycaemic or if their blood glucose is less than 4.0 mmol/L. Driving should not be resumed until 45 minutes after blood glucose has returned to normal.
  • Patients should carry rapidly absorbed sugar in their vehicle and stop, turn off the ignition and eat it if there are any warning signs.
  • A card should be carried to say which medications they are using, to aid with resuscitation if needed.
  • If an accident is due to hypoglycaemia, a diabetic driver may be charged with driving under the influence of drugs.

Diabetics who are managed by oral hypoglycaemics may not need to notify:

  • If they have not had more than one episode of hypoglycaemia requiring the assistance of another person within the preceding 12 months; and
  • they monitor blood glucose regularly (at times relevant to driving to enable the detection of hypoglycaemia); and
  • they are under regular medical review; and
  • they have none of the other DVLA criteria, eg laser eye treatment or peripheral vascular disease.

Epilepsy attacks are the most frequent cause of collapse whilst driving.

  • After a first seizure the person should have six months off driving from the date of the seizure for Group 1 (car or motorcycle) entitlement. If there are clinical factors or investigation results which suggest an unacceptably high risk of a further seizure, ie 20% or greater per annum, this may be extended.
  • A known epilepsy sufferer who has suffered an attack awake or asleep, must refrain from driving for one year from the date of the attack. If their initial seizure was whilst asleep more than three years previously and they have had no attacks whilst awake during that period, then they may be licensed even though sleeping attacks may still occur. If an attack whilst awake subsequently occurs, then the formal epilepsy regulations apply and require at least one year off driving from the date of the attack.
  • In any event, they should not drive if they are likely to cause danger to the public or to themselves.
  • Patients with transient ischaemic attack (TIA) or cerebrovascular event should not drive for at least one month.
  • If TIAs have been recurrent and frequent, a three-month period free of attacks may be required.
  • Patients who have had a single episode of loss of consciousness (no cause found) still need to have at least one year off driving.
  • Disabling giddiness, vertigo and problems with movements preclude driving until there is satisfactory control of symptoms.
  • DVLA needs to know about unexplained blackouts, multiple sclerosis, Parkinson's disease (any freezing or on/off effects), motor neurone disease, recurrent TIAs and cerebrovascular events.
  • In the latter, the licence is usually withheld for three months depending on an examination by an independent doctor and sometimes a driving test.
  • Those with dementia should only drive if the condition is mild (do not rely on armchair judgements: on-the-road trials are better).

The DVLA states that:

'Age is no bar to the holding of a licence. DVLA requires confirmation at age of 70 that no medical disability is present, thereafter a 3-year licence is issued subject to satisfactory completion of medical questions on the application form. Notwithstanding, as ageing progresses, a driver or his relative(s) may be aware that the combination of progressive loss of memory, impairment in concentration and reaction time with possible loss of confidence, suggest consideration be given to cease driving. Physical frailty is not per se a bar to the holding of a licence.'

A Canadian paper showed that a near accident or accident was the only factor that would lead many to stop driving. Few elderly drivers plan for stopping driving.[3]

Encourage relatives to contact DVLA if they believe a relative who has dementia should not be driving. Many elderly drivers (approximately 1 in 3) who die in accidents are found to have Alzheimer's disease.

GPs may have concerns about breaching confidentiality (by contacting the DVLA) when they have concerns about patients with mental illness or dementia. They are advised to seek advice from their defence union before doing so.

Drivers may need to be considered for re-licensing by the DVLA if:

  • There is severe mental disorder (including severe mental impairment).
  • There are severe behavioural disorders.
  • There is alcohol dependency (including inability to refrain from drink driving).
  • There is drug abuse and dependency.
  • Anti-psychotic medication is taken in quantities sufficient to impair driving ability.
  • Visual acuity (± spectacles) is insufficient: it should be sufficient to read a 79.4 mm-high number plate at 20.5 metres.
  • Visual field is not full in monocular vision. Monocular vision is allowed only if the visual field is full.
  • Binocular field of vision is below 120°. Binocular field of vision must be ≥120°.
  • Diplopia is not mild and not correctable. Diplopia is not allowable unless mild and correctable, eg by an eye patch.
Driving, or being in charge of a vehicle when under the influence (including any side-effect) of a drug is an offence under the Road Traffic Act 1988.

Many drugs affect alertness and driving ability - check data sheets.

Many are potentiated by alcohol so warn patients:

  • Not to drive until they are sure of side-effects.
  • Not to drink and drive.
  • Not to drive if feeling unwell.
  • Never to drive within 48 hours of a general anaesthetic.

Patients

By post, fax, email, or telephone
Drivers Medical Group
DVLA
Swansea
SA99 1TU
Fax: 0845 850 0095
Email: go to www.gov.uk/contact-the-dvla
Telephone: 0300 790 6806 (car drivers and motorcyclists)
Telephone: 0300 790 6807 (bus, coach and lorry drivers)

 

Medical professionals only

Address for enquiries in England, Scotland and Wales
The Medical Adviser
Drivers Medical Group DVLA
Longview Road
Morriston
SWANSEA
SA99 1TU
Tel: 01792 782337 (Medical Professionals Only)
Email: medadviser@dvla.gsi.gov.uk (Medical Professionals Only)

Further reading & references

  • Martin AJ, Marottoli R, O'Neill D; Driving assessment for maintaining mobility and safety in drivers with dementia. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD006222.
  1. At a glance guide to the current medical standards of fitness to drive; Driver and Vehicle Licensing Agency
  2. Essex N, Watkins PJ, Durston J; Drivers who take insulin must tell driver and vehicle licensing agency. BMJ. 2000 Apr 22;320(7242):1148.
  3. Rudman D, Friedland J, Chipman M, et al; Holding On and Letting Go: The Perspectives of Pre-seniors and Seniors on Driving Self-Regulation in Later Life.; Can J Aging. 2006 Spring;25(1):65-76.

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.

Original Author:
Dr Hayley Willacy
Current Version:
Peer Reviewer:
Dr Huw Thomas
Last Checked:
19/10/2011
Document ID:
1294 (v24)
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