Driving advice for professionals

Summary of the UK guidelines

The DVLA deals with all aspects of driver licensing when there are medical conditions that impact, or potentially impact, on safe control of a vehicle. There are two types of licence holders with age limits applicable to both:

• Group 1 – cars and motorcycles
• Group 2 – large lorries (category C) and buses (category D)

There are also standards for  police, fire, ambulance and health service drivers, with licences for taxis the responsibility of local authorities.

DVLA guidance states that doctors and other healthcare professionals should:

• advise the individual on the impact of their medical condition for safe driving ability
• advise the individual on their legal requirement to notify the DVLA of any relevant condition
• treat, manage and monitor the individual’s condition with ongoing consideration of their fitness to drive
• notify the DVLA when fitness to drive requires notification but an individual cannot or will not notify the DVLA themselves

Applicants and licence holders have a legal duty to:

• notify the DVLA of any injury or illness that would have a likely impact on safe driving ability (except some short-term conditions)
• respond fully and accurately to any requests for information from either the DVLA or healthcare professionals
• comply with the requirements of the issued licence, including any periodic medical reviews indicated by the DVLA

The DVLA provides specific advice for assessment of driving after a stroke or TIA including amaurosis fugax. In summary, group 1 licence holders who have a stroke must not drive for a month and can only resume if there has been a satisfactory clinical recovery, especially visual field defects and cognitive defects and impaired limb function. The DVLA only has to be notified if recovery is not deemed satisfactory.

People who have a single TIA must not drive for a month and don’t need to notify the DVLA.

Those who have multiple strokes/TIAs must not drive for 1 month following their most recent stroke/TIA and can only resume if there has been a satisfactory clinical recovery, especially visual field defects and cognitive defects and impaired limb function. The DVLA only has to be notified if recovery is not deemed satisfactory.

The criteria for group 2 drivers are more onerous for both stroke and TIA, with the licence refused/revoked for a year.

Absolute bars to driving include epileptic seizure (excluding seizure within 24 hours of stroke onset), significant visual field defects, reduced visual acuity or double vision). If any of these are evident, the patient needs to inform the DVLA and not drive.

The National Clinical Guidelines for Stroke 2023 recommends:

• People who have had an acute stroke or TIA should be asked about driving before they leave the hospital or specialist outpatient clinic
• People with persisting cognitive, language or motor disability after stroke who wish to return to driving should be referred for on-road screening and evaluation.
• People with stroke who wish to drive should:
  • be advised of the exclusion period from driving and their responsibility to notify the DVLA
  • If they have any persisting disability which may affect their eligibility;
    • be asked about or examined for any absolute bars to driving e.g. epileptic seizure (excluding seizure within 24 hours of stroke onset), significant visual field defects, reduced visual acuity or double vision
    • be offered an assessment of the impairments that may affect their eligibility, including their cognitive, visual and physical abilities
    • receive a written record of the findings and conclusions, copied to their general practitioner
• People who wish to drive after stroke should be informed about eligibility for disabled concessions

Best practice pathway for stroke/TIA

The following pathway is based on the relevant guidelines and examples of local best practice. Right click on the image below to view pathway in larger font. There is some evidence for assessments that most accurately predict driving performance (which should include examination of cognition, visual or physical impairments), however, many have limitations such as being unsuitable for aphasia and as a result there is significant variation in local practice.

Resources including websites, leaflets plus example forms and letters are presented at the bottom of the page.

Please note that, Large Goods Vehicle (LGV) and Passenger Carrying Vehicle (PCV) licences are categorised under Group 2 by the DVLA and therefore stroke and TIA patients with these licences should follow the Group 2 pathway.

The DVLA also provides specific advice for assessment of driving for a number of neurological conditions, including individuals with a Serious Neurological Disorder, Epilepsy, Chronic Neurological Disorders (including Multiple Sclerosis and Motor Neurone Disease), Parkinson’s Disease, Benign Brain Tumours, Malignant Brain Tumours, Traumatic Brain Injuries. For a full list of conditions and their specific guidance click here.

The British and Irish Orthoptic Society published a driving pathway in 2020 and have also released a leaflet.

Best practice for neurological condition (excluding stroke)

The following guidelines were developed through a GM Task and Finish Group and Neuro Patient & Carer Group. They are based off relevant guidelines and local best practice. Right click on the image below to view pathway in larger font.

Resources including websites, leaflets plus example forms and letters are presented at the bottom of the page.