How Doctors Can Help

Doctors

The role of the medical profession in declaring a driver unfit to hold a licence is widely misunderstood.

Every driver is personally legally responsible for informing the DVLA (or the DVA in Northern Ireland) if they have a condition or are undergoing treatment that may affect their ability to drive safely.

However, there are circumstances in which a doctor should inform the DVLA (or the DVA) and disclose any relevant medical information, in confidence, to the medical adviser, even if the patient does not give their consent, or withholds consent. For example, if a doctor is unable to persuade a patient to stop driving, or if they discover that a patient is continuing to drive against their advice.

The General Medical Council issues clear guidelines to doctors in "Confidentiality: reporting concerns about patients to the DVLA or the DVA". These were updated on 25 April 2017 and now state:

"Trust is an essential part of the doctor-patient relationship and confidentiality is central to this. Patients may avoid seeking medical help, or may under-report symptoms, if they think that their personal information will be disclosed by doctors without consent, or without the chance to have some control over the timing or amount of information shared.

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.

You should ask for a patient’s consent to disclose information for the protection of others unless it is not safe or practicable to do so, or the information is required by law. You should consider any reasons given for refusal.

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.

If you consider that failure to disclose the information would leave individuals or society exposed to a risk so serious that it outweighs patients’ and the public interest in maintaining confidentiality, you should disclose relevant information promptly to an appropriate person or authority. You should inform the patient before disclosing the information, if it is practicable and safe to do so, even if you intend to disclose without their consent."

The GMC Guidelines also set out the steps doctors should take if a patient’s failure or refusal to stop driving exposes others to a risk of death or serious harm:

"If a patient has a condition or is undergoing treatment that could impair their fitness to drive, you should:

a explain this to the patient and tell them that they have a legal duty to inform the DVLA or DVA

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

c make a note of any advice you have given to a patient about their fitness to drive in their medical record.

If a patient is incapable of understanding this advice – for example, because of dementia – you should inform the DVLA or DVA as soon as practicable.

If a patient refuses to accept the diagnosis, or the effect of the condition or treatment 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. As long as the patient agrees, you may discuss your concerns with their relatives, friends or carers.

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, or you discover that they are continuing to drive against your advice, you should consider whether the patient’s refusal to stop driving leaves others exposed to a risk of death or serious harm. If you believe that it does, you should contact the DVLA or DVA promptly and disclose any relevant medical information, in confidence, to the medical adviser."

The full General Medical Council guidelines can be downloaded at "Confidentiality: reporting concerns about patients to the DVLA or the DVA".

The medical process

Once the licence holder has informed DVLA (or the DVA in Northern Ireland) of their condition and provided consent, medical enquiries will be made. The DVLA (or the DVA) will send the person a questionnaire that seeks their permission to obtain medical reports from the person’s GP and or specialist.

Based on the medical information received, medical advisors at the DVLA (or the DVA) will make a decision as to whether the person can continue to drive. It can be a relatively lengthy process to obtain all necessary reports and, during this period, the licence holder normally retains legal entitlement to drive.

The doctor in change of their care should be able to advise the driver whether or not it is appropriate for them to continue to drive during this period.

They may also be asked to take a driving assessment, normally at a mobility centre.

When the DVLA (or the DVA) receive a notification from a doctor in accordance with the GMC guidelines, they can normally only send an acknowledgement to the doctor confirming receipt of the notification. However, if they have a condition that legally bars them from holding a licence, the DVLA (or DVA) can inform the doctor of this.

If a doctor is concerned about their patient but doesn’t know if they have a licence to drive, they should to notify DVLA (or DVA) of their concerns.

The DVLA does not routinely tell doctors of the outcome of a medical enquiry, although the driver is, of course, informed of the outcome, which might be they can carry on driving, be issued with a restricted licence that is valid for 1, 2 or 3 years or have their licence revoked or refused. However, in cases where there is cognitive impairment, dementia or a mental health condition, and the driver may not have the insight and/or memory function to abide by the refusal/revocation of their licence, the DVLA will usually write to the GP informing them of the licensing decision.

How Doctors Can Help

The medical process

Further Information