Occupational health professionals can play an important role in helping to assess a worker’s fitness to drive for or during work. Dr Nick Jenkins of the DVLA outlines how the agency’s Group 1 and Group 2 standards work, what it looks for from medical professionals and its notification protocols.
I am the senior doctor at the Driver and Vehicle Licensing Agency (DVLA). The DVLA is an executive agency of the Department for Transport and is the driver licensing authority in GB. There are currently in excess of 48 million licence holders in GB. Around 4% of GB licence holders have advised the DVLA that they have a medical condition that could affect their fitness to drive.
We are obliged to apply the appropriate standards and maintain road safety while balancing this against the individual’s desire to remain mobile. We are keenly aware that ongoing mobility can be hugely important in combating social isolation, especially in later years. To do this we are working in an increasingly collaborative manner with drivers, the medical profession and all other healthcare professionals who are involved in the driver’s medical care.
About the author
Nick Jenkins is senior doctor at the Driver and Vehicle Licensing Agency (DVLA)
Around 650 staff, approximately 10% of the DVLA workforce, are employed in dealing with medical cases. This includes 38 DVLA doctors and nine nurse caseworkers who come from a variety of backgrounds, including primary care, occupational medicine and a variety of secondary care specialties.
My own background involved 24 years as a full-time emergency medicine (A&E) consultant. After leaving substantive clinical practice to join the DVLA, I continued to undertake regular weekend shifts and I found my DVLA work helped to inform my clinical practice, allowing me to better advise patients whose medical conditions were relevant to their driving.
Equally, the continued patient contact helped me to appreciate the individual nature of each of our patients who have medical conditions to which standard requirements apply. All of our doctors and nurse caseworkers undergo an in-house training period of at least six months before considering cases independently. During this period particular attention is given to the legal framework within which the licensing process operates.
Online A-Z guide of medical conditions
The range of medical conditions that potentially impact upon driving is large. Increasingly, and mirroring the situation in clinical practice, we are dealing with the complexities that arise when a driver has multiple co-morbidities.
To help drivers to decide whether they need to tell DVLA about their condition, 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
We provide detailed guidance for medical professionals, too. It is perhaps not widely enough known that Britain was in fact the first country to publish medical standards for fitness to drive.
The Medical Commission on Accident Prevention published “Medical aspects of fitness to drive” in 1968. This was replaced by the DVLA’s “At a glance” guide to the current medical standards of fitness to drive. The most recent version of Assessing Fitness to Drive – a guide for medical professionals was published in February 2020. Many countries have, over the years, looked to our published guidance as a benchmark for their own driver licensing standards and guidelines.
The medical standards are shaped by domestic legislation (Road Traffic Act 1988 and the Motor Vehicles (Driving Licences) Regulations 1999) and also by the current requirements of European directive.
There are relatively few conditions that are specifically covered by legislation (for example vision, epilepsy, diabetes). However, legislation does provide a framework upon which the standards for all other conditions are developed, with condition specific advice provided by the secretary of state for transport’s honorary medical advisory panels.
These panels comprise clinicians and lay members, the clinicians being leading experts in their relevant fields with a specific interest in the impact of the given medical condition upon driving. The six expert panels cover diabetes, alcohol and drug misuse/dependency, cardiovascular disease, neurological disease, visual disorders, and psychiatric disorders.
The panels meet twice a year and our published guidance is regularly updated as a result of that advice. Clinicians are able to sign up for email alerts to such updates.
Group 1 and Group 2 medical standards
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 a vocational driver typically spends at the wheel.
Applicants for Group 2 licences must undergo a medical examination (known as the D4 examination) and this examination is required on application. A medical is required every five years from age 45 until the age of 65, and thereafter annually.
The examination must be completed by a registered medical practitioner (RMP), although the vision assessment may be undertaken by an optician or optometrist.
We recognise that some employment-related driving involves vehicles categorised as Group 1. However, it would be for an employer to consider whether a higher medical standard should be required for their drivers.
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.
Health professionals, notably within a workplace setting occupational health, 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.
Licences of shorter duration (between one and five years) are issued to people whose medical condition is progressive (for example, dementia), where we need to assess the ongoing stability of that condition (for example, diabetes) or to consider the risk of recurrence of an episode being below a certain threshold (for example, epileptic seizure).
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.
Advice and guidance for occupational health
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 (for example the General Medical Council (GMC), the General Optical Council (GOC) and the medical royal colleges) to help maintain awareness of the standards amongst the diverse group of healthcare professionals caring for patients with conditions that might impact upon driving.
There have been high-profile cases (for example, the tragic 2014 Glasgow bin lorry crash) where there has been a loss of life or life-changing injury as a result of a medical episode or where a driver has failed to notify or withheld their medical history from the DVLA or 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 the number of notifications we receive from doctors and also from other healthcare professionals.
Similar guidelines have been issued by the College of Optometrists. The DVLA has also more recently worked with the GOC to develop guidance and its consultation regarding that guidance was launched in March last year. In the absence of similar guidance from other regulatory bodies, many healthcare professionals are choosing to refer to GMC guidance when deciding whether or not to disclose information to the DVLA.
To conclude, the DVLA received around 750,000 medical cases 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. The vast majority of notifications were made by the driver themselves.
When we receive a notification from a driver or a third party we begin a medical investigation in order to establish whether the health standards are met. We receive the information required to make licensing decisions by way of a series of discrete stages. The majority of notifications relate to a single medical condition and information is gathered using condition specific medical questionnaires.
The questionnaire is analysed by specially trained clerical staff who extract structured medical information by following operating instruction, and can arrive at a licensing decision in straightforward cases.
Where further information is required, the operating instructions will direct staff to send a request for further information to the individual’s clinician using a more detailed questionnaire.
We will often be wholly reliant on receiving this information to progress our enquiries and at any one time approximately 60% of all “live” cases are waiting for the return for such information.
In the majority of cases, a licensing decision can be made following receipt of the questionnaire from a clinician, the most complex of these cases being decided by the medically qualified members of our team.
In certain medical conditions, specific medical examinations or assessments will be required before a licensing decision can be made. Examples of such investigations include visual field testing, exercise treadmill or cardiac scans, and on-road driving assessments. We will commission such investigations when they are required to allow us to make a fully evidenced licensing decision.
My hope is that through this article, occupational health practitioners will feel more confident in advising their patients about health and driving. In addition to the help our online guidance provides, I would encourage any healthcare professional with any questions to telephone the DVLA “doctor-to-doctor” telephone line (01792 782337) to discuss their patient with a DVLA doctor. You may choose not to provide your patient’s details should you prefer.
You can also use this telephone service to clarify any issues regarding to fitness to drive or you contact DVLA using its secure email service (firstname.lastname@example.org).
We aim to provide enquiries to this service with a response from one of the DVLA doctors within one working day and we often find this means of communication best when complex issues need to be considered.
Whichever form of communication you choose, we will provide you with the best advice to hopefully enable your patient to continue driving safely.
Online A-Z guide of medical conditions and driving, www.gov.uk/health-conditions-and-driving
Assessing Fitness to Drive – a guide for medical professionals, February 2020, available online at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/866655/assessing-fitness-to-drive-a-guide-for-medical-professionals.pdf
Confidentiality: good practice in handling patient information, GMC, https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/confidentiality
Confidentiality: patients’ fitness to drive and reporting concerns to the DVLA or DVA, GMC, https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/confidentiality—patients-fitness-to-drive-and-reporting-concerns-to-the-dvla-or-dva
2014 Glasgow bin lorry crash, https://en.wikipedia.org/wiki/2014_Glasgow_bin_lorry_crash