Patients' fitness to drive and reporting concerns to the DVLA/ DVA

Revised guidance on confidentiality

The General Medical Council has published revised guidance on confidentiality for all doctors practising in the UK. It comes into effect on 25 April 2017. Until then the current GMC guidance published in 2009 remains in place.

Specific situations that doctors may find difficult

The GMC has also published explanatory notes to show how the new guidance applies to situations doctors may encounter that they find difficult. One of these situations covers when a doctor should report concerns to the DVLA/DVA about a patient's fitness to drive. This updated guidance:

• Emphasises the importance of doctors considering whether a patient's condition may affect their ability to drive safely.
• Includes an overt expression of doctors' duties to protect and promote the health of patients and the public, as well as to respect confidentiality.
• Confirms that the same principles apply if doctors are concerned about the fitness of drivers and pilots of other kinds of regulated transport, including by rail, water and air.
• Reminds doctors to keep a record of the advice they give, and the disclosures they make.

Assessing a patient

The DVLA/DVA needs to know if a person with a driving licence has a condition or is having treatment which may affect their safety as a driver. When assessing a patient a doctor should refer to the DVLA guidance Assessing fitness to drive – a guide for medical professionals.  It is always a difficult decision for clinicians to make as to whether to disclose information to the DVLA/DLA.  If the doctor is not sure they should seek advice from a senior colleague.

Discussion with the patient

The driver is legally responsible for informing the DVLA/DLA about a condition or treatment which can impair their fitness to drive.  Further, the DVLA/DLA is responsible for deciding if a person is unfit to drive based on relevant evidence.  As such the DVLA/DLA needs to know when driving licence holders have a condition or issue which may now, or in the future, affect their safety as a driver.

If a patient has a condition or is having treatment which may impair their fitness to drive, the doctor should:

• Inform the patient and explain that the condition/treatment may affect their ability to drive and why this is the case.
• Explain that the patient has a legal duty to tell the DVLA/DVA.
• Explain that they (the clinician) may be obliged to tell the DVLA/DVA if the patient continues to drive.
• Make a clear note of the discussion in the records

When should a doctor contact the DVLA/DVA

• If the patient has dementia or does not have capacity, the doctor should inform the DVLA/DVA as soon as possible of the relevant conditions which may affect that individual's ability to drive.
• If a patient does not agree that their ability to drive is impaired, the doctor could suggest that they seek a second opinion and help to arrange this. The patient should be advised not to drive in the meantime.

If a patient refuses to stop driving and the doctor believes that the patient's driving exposes others to serious harm, the doctor should:

• Make every reasonable effort to persuade the individual to stop driving.
• Where possible, inform the patient of their intention to disclose personal information to the DVLA/DVA. If the patient objects consider any reasons the patient gives.
• Confirm this in writing to the patient.
• Make a clear note on the patient's record.
• Contact the DVLA/DVA promptly and disclose relevant medical information in confidence to the medical adviser.

Once the DVLA/DLA has been informed you should also write to the patient where possible to confirm that a disclosure has been made.

A patient should understand that simply because they have a reportable condition, it does not mean that they will automatically be precluded from driving, but the DVLA/DLA will make that determination based on medical information and any subsequent questionnaire or assessment.

How we can help

Making decisions about when to share confidential information can often be difficult and stressful. In relation to any decision the issues and grounds of disclosure need to be considered, if appropriate debated and then clearly documented in the notes.

Bevan Brittan has substantial experience in advising healthcare professionals in connection with the disclosure of confidential information. If you would like to discuss any of the issues raised please contact us.

Resources

• Confidentiality: patients' fitness to drive and reporting concerns to the DVLA or DVA.
• Assessing fitness to drive – a guide for medical professionals.
• What's changed in the confidentiality guidance? - GMC
• Good practice in handling patient information
• My GMP – The GMC have created a new app which signposts to the revised guidance and which in April will also have additional resources and case studies.