Guidance

Miscellaneous conditions: assessing fitness to drive

Advice for medical professionals to follow when assessing drivers with miscellaneous conditions.

✘- Must not drive ! - May continue to drive subject to medical advice and/or notifying the DVLA ✓- May continue to drive and need not notify the DVLA

Excessive sleepiness – including obstructive sleep apnoea syndrome

‘Excessive sleepiness’ having, or likely to have, an adverse effect on driving includes:

Legislation states that objective sleep study measurements for driving assessment purposes should use the apnoea-hypopnoea index (AHI). Recognising that not all sleep services use AHI, the DVLA will accept results of equivalent objective tests.

The ‘Tiredness can kill’ leaflet (INF159) is for drivers concerned about excessive sleepiness.

  Group 1
car and motorcycle
Group 2
bus and lorry
Excessive sleepiness
due to a medical condition (see relevant section) including mild obstructive sleep apnoea syndrome (AHI below 15) or medication
✘- Must not drive.

Driving may resume only after satisfactory symptom control.

If symptom control cannot be achieved in 3 months the DVLA must be notified.
✘- Must not drive.

Driving may resume only after satisfactory symptom control.

If symptom control cannot be achieved in 3 months the DVLA must be notified.
Excessive sleepiness due to obstructive sleep apnoea syndrome – moderate and severe:

■ AHI 15 to 29 (moderate)
■ AHI 30 or more (severe) on the apnoea-hypopnoea index or equivalent sleep study measure
✘- Must not drive and must notify the DVLA.

Subsequent licensing will require:

■ control of condition
■ sleepiness improved
■ treatment adherence.

The DVLA will need medical confirmation of the above, and the driver must confirm review to be undertaken every 3 years at the minimum.
✘- Must not drive and must notify the DVLA.

Subsequent licensing will require:

■ control of condition
■ sleepiness improved
■ treatment adherence.

The DVLA will need medical confirmation of the above, and the driver must confirm review to be undertaken annually at the minimum.
Excessive sleepiness due to suspected obstructive sleep apnoea syndrome ✘- Must not drive.

Driving may resume only after satisfactory symptom control.

If symptom control cannot be achieved in 3 months the DVLA must be notified.

See ‘Excessive sleepiness due to obstructive sleep apnoea syndrome’ above when diagnosis is confirmed.
✘- Must not drive.

Driving may resume only after satisfactory symptom control.

If symptom control cannot be achieved in 3 months the DVLA must be notified.

See ‘Excessive sleepiness due to Obstructive sleep apnoea syndrome’ above when diagnosis is confirmed.

Profound deafness

  Group 1
car and motorcycle
Group 2
bus and lorry
  ✓- May drive and need not notify the DVLA.

Ordinary eligibility for a ’til 70 licence.
! - Must be assessed but may not need to notify the DVLA.

For licensing, the paramount importance is placed on a proven ability to communicate in an emergency by:

■ speech
or
■ suitable alternative, for example SMS text.

Inability is likely to result in a licence being refused or revoked.

Cancers – not covered in other chapters

  Group 1
car and motorcycle
Group 2
bus and lorry
In both driving groups, fitness to drive is affected by the risk of seizure Chapter 1.

All cases of eye cancer must meet the minimum requirements for vision (Chapter 6).
! - Must be assessed but may not need to notify the DVLA.

If there is a likelihood of cerebral metastasis and seizure, the DVLA must be notified.

There must be no significant complication relevant to driving, such as:

■ specific limb impairment, for example due to bone tumour, primary or secondary
■ general impairment, for example due to advanced malignancy producing symptoms such as general weakness or cachexia that affects driving.

The effects of any cancer treatment must also be considered – the generally debilitating effects of chemotherapy and radiotherapy in particular.
! - Must be assessed but may not need to notify the DVLA.

Licensing requires specific consideration of the likelihood of cerebral metastasis and seizure, and there must be no complications, such as:

■ specific limb impairment, for example due to bone tumour, primary or secondary
■ general impairment, for example due to advanced malignancy producing symptoms such as general weakness or cachexia that affects driving.

The effects of any cancer treatment must also be considered – the generally debilitating effects of chemotherapy and radiotherapy in particular.

Acquired immune deficiency syndrome (AIDS)

HIV infection without AIDS

If there is no AIDS-defining illness, people with HIV may drive and do not need to inform the DVLA of their status.

  Group 1
car and motorcycle
Group 2
bus and lorry
AIDS diagnosed ! - May drive and must notify the DVLA.

Licensing may be granted for medical review after 1, 2 or 3 years if enquiries from the DVLA find no disability likely to affect driving.
! May drive and must notify the DVLA.

Licensing will be considered individually.

Eligibility will require no symptoms likely to affect driving and the maintenance of a CD4 count of 200 cells/microliter for at least 6 months.

Older age is not necessarily a barrier to driving.

  • Functional ability, not chronological age is important in assessments.
  • Multiple comorbidity should be recognised as becoming more likely with advancing age and considered when advising older drivers.
  • Discontinuation of driving should be given consideration when an older person – or people around them – become aware of any combination of these potential age-related examples:
    • progressive loss of memory, impaired concentration and reaction time, or loss of confidence that may not be possible to regain.
  • Physical frailty in itself would not necessarily restrict licensing, but assessment needs careful consideration of any potential impact on road safety.
  • Age-related physical and mental changes vary greatly between individuals, though most will eventually affect driving.
  • Professional judgement must determine what is acceptable decline and what is irreversible and/or a hazardous deterioration in health that may affect driving. Such decisions may require specialist opinion.

The DVLA has medical advisers ready to provide guidance to healthcare professionals.

  Group 1
car and motorcycle
Group 2
bus and lorry
Older age ! - When drivers reach the age of 70, they must confirm to the DVLA that they have no medical disability.

Drivers over 70 receive a licence for 3 years after fitness to drive has been declared, to include satisfactory completion of medical questions in the application.
! - Bus and lorry drivers:

■ must make fresh licence applications every 5 years from the age of 45
■ annually from the age of 65.

Each application must be accompanied by medical confirmation of satisfactory fitness to drive.

Transplant – not covered in other chapters

  Group 1
car and motorcycle
Group 2
bus and lorry
  ! - May drive and need not notify the DVLA.

Except: there must be no other, or underlying condition that requires any restriction or notification to the DVLA.
! - May drive and need not notify the DVLA.

Except: there must be no other, or underlying condition that requires any restriction. Failing this, the DVLA must be notified and may require individual assessment.

Device or implants – not covered in other chapters

  Group 1
car and motorcycle
Group 2
bus and lorry
  ! - May drive and need not notify the DVLA.

Except: there must be no other, or underlying condition that requires any restriction or notification to the DVLA.
! - May drive and need not notify the DVLA.

Except: there must be no other, or underlying condition that requires any restriction. Failing this, the DVLA must be notified and may require individual assessment.

Cognitive decline or impairment after stroke or head injury

There is no single simple marker for the assessment of impaired cognitive function relevant to driving, although the satisfactory ability to manage day-to-day living could provide a yardstick of cognitive competence.

In-car, on-the-road assessments are an invaluable way of ensuring, in valid licence holders, there are no features liable to present a high risk to road safety, including these examples:

  • visual inattention, notable distractibility, impaired multi-task performance.

The following are also important in showing there is no impairment likely to affect driving:

  • adequate performance in reaction times, memory, concentration and confidence.

Cognitive disability

  Group 1
car and motorcycle
Group 2
bus and lorry
  ✘- Must not drive and must notify the DVLA.

Impairment of cognitive functioning is not usually compatible with the driving of these vehicles. Mild cognitive disability may be compatible with safe driving – individual assessment will be required.
✘- Must not drive and must notify the DVLA.

Impairment of cognitive functioning is not usually compatible with the driving of these vehicles. Mild cognitive disability may be compatible with safe driving – individual assessment will be required.

Driving after surgery

Evaluating the likely effects of postoperative recovery.

Notwithstanding any restrictions or requirements outlined in other chapters of this document, drivers do not need to notify the DVLA of surgical recovery unless it is likely to affect driving and persist for more than 3 months.

Licence holders wishing to drive after surgery should establish with their own doctors when it would be safe to do so.

Any decision regarding returning to driving must take into account several issues, including:

  • recovery from effects of procedure
  • anaesthetic recovery from the effects of the procedure
  • any distracting effect of pain
  • analgesia-related impairments (sedation or cognitive impairment)
  • other restrictions caused by the surgery, the underlying condition or any comorbidities.

Drivers have the legal responsibility to remain in control of a vehicle at all times.

Drivers must ensure they remain covered by insurance to drive after surgery.

Temporary medical conditions

Drivers generally do not need to notify the DVLA of conditions for which clinical advice has indicated less than 3 months of no driving.

If the judgement of the treating clinician is that the DVLA needs to be notified, the healthcare professional should advise the patient to contact the DVLA.

Such a judgement may be necessary for any of a range of conditions that may temporarily affect driving, including, but not limited to:

  • postoperative recovery (see Driving after surgery)
  • severe migraine
  • limb injuries expected to show normal recovery
  • pregnancy associated with fainting or light-headedness
  • hyperemesis gravidarum
  • hypertension of pregnancy
  • recovery following Caesarean section
  • deep vein thrombosis or pulmonary embolism.

Fractures

A driver does not need to notify the DVLA of the fact of a fracture, but if recovery post-fracture is prolonged for more than 3 months, the treating clinician should offer advice on a safe time to resume driving.

Medication effects

It is an offence to drive or attempt to drive while unfit because of alcohol and/or drug use – and driving laws do not distinguish between illegal and prescribed drugs.

Drivers taking prescribed drugs subject to the drug-driving legislation will need to be advised to carry confirmation that these were prescribed by a registered medical practitioner.

Some prescription and over-the-counter medicines can affect driving skills through drowsiness, impaired judgement and other effects.

Prescribers and dispensers should consider any risk of medications, single or combined, in terms of driving – and advise patients accordingly.

Without providing an exhaustive list, the following drug groups require consideration:

  • benzodiazepines – these may cause sufficient sedation to make driving unsafe
  • antidepressants – sedating tricyclics have a greater propensity to impair driving than SSRIs, which are less sedating. Advice for individual driving safety should be considered carefully for all antidepressants
  • antipsychotics – many of these drugs will have some degree of sedating side effect via action on central dopaminergic receptors. Older drugs (chlorpromazine, for example) are highly sedating due to effects on cholinergic and histamine receptors. Newer drugs (olanzapine or quetiapine, for example) may also be sedating; others less so (risperidone, ziprasidone or aripiprazole, for example)
  • opioids – cognitive performance may be reduced with these, especially at the start of use, but neuro-adaptation is established in most cases. Driving impairment is possible because of the persistent miotic effects of these drugs on vision.

Also refer to Chapter 4, psychiatric disorders, and Chapter 5, drug or alcohol misuse and dependence.

Published 11 March 2016
Last updated 1 January 2018 + show all updates
  1. Inclusion of hypersomnias/narcolepsy as conditions also considered under ‘excessive sleepiness’.
  2. Updates to 'Excessive sleepiness - including obstructive sleep apnoea syndrome'.
  3. Minor update.
  4. Content updated.
  5. Changes to information under excessive sleepiness – including obstructive sleep apnoea syndrome.
  6. First published.