The principal source of guidance for GPs in relation to fitness to drive assessments is ‘Sláinte & Tiomáint - Medical Fitness to Drive Guidelines’. It provides guidance on medical fitness to drive under the broad headings of neurological disorders, cardiovascular disorders, diabetes mellitus, psychiatric disorders, drug and alcohol misuse, visual disorders, renal disorders, respiratory and sleep disorders.1
At Medisec, we frequently receive queries on the obligations and requirements of a GP for reporting on a patient’s fitness to drive. A driver should inform the NDLS and their insurance provider of any long-term or permanent injury or illness that could cause or increase the risk of impairment while driving. They will require a medical report to support their application for, or renewal of, a licence. In the case of NDLS medical examinations, drivers have a duty to declare their health status to the examining health professional. Drivers are also required to report to the NDLS when they become aware of a health condition that may affect their ability to drive safely.
A driver should not drive while medically unfit to do so and can be convicted of an offence for doing so. Drivers must adhere to prescribed medical treatment and monitoring/management plans for their condition.
You have a duty to advise patients on the impact of medical conditions and treatments on their ability to drive, and to recommend restrictions and ongoing monitoring as required. Such restrictions/monitoring requirements should be recorded in patient records and noted on the NDLS medical report as per the guidelines.
You are also expected to advise the patient of their responsibility to report their condition to the NDLS if indicated (who may amend or revoke the licence). In Ireland, there is no medical condition that routinely requires reporting by a health professional directly to the NDLS. A positive duty is imposed on health professionals to notify the relevant authority in writing of a belief that a driver is physically or mentally unfit to drive, poses a risk to public safety and is not compliant with professional advice to stop driving. In urgent situations outside of normal working hours you can make a report to the Gardaí rather than the NDLS. It is preferable that such action should be taken with the driver’s consent when possible and with the driver’s knowledge of the planned action. In exceptional circumstances e.g. risk of violence to the health professional, a decision not to inform the driver of a planned report may need to be considered. See Sláinte & Tiomáint for useful guidance on this.
Case study: a middle-aged male first presented to his GP with a recent history of heavy binge drinking. There were stressful life changes at the time and he presented as highly motivated to reverse his alcohol pattern and as having good insight into the risks of ongoing drinking. Biomarkers were elevated in this case. His occupation involved commercial driving for his employer under a Group 2 licence category. His occupational health doctor agreed with his GP that he did not present as alcohol dependent. Issues relating to driving were discussed with the patient including the risk of having his licence revoked in the case of ‘persistent alcohol misuse’. The patient undertook to attend support services to cease drinking.
Following further reviews it became clear that he was continuing to engage in ‘persistent alcohol misuse’. On foot of Medisec’s advice, his GP advised him verbally and by letter (which included a copy of the relevant extracts from Sláinte & Tiomáint) that he should cease driving under his Group 2 licence for a minimum of one year of abstinence, or controlled drinking pending reviews, and advised of his obligation to notify the NDLS and his insurers. The GP informed the patient he would not be able to drive for a minimum of three months of abstinence or controlled drinking, pending review under his Group 1 licence. The GP also informed the patient that should he learn that the patient had not complied with this advice, a written report would have to be forwarded to the NDLS. The GP documented his advice to the patient clearly in the medical notes.
This case study indicates the clear shared responsibility of a GP and a patient in relation to the certification of a patient’s fitness to drive. If you have any doubts about a patients fitness to drive or the impact of a particular condition on fitness to drive you can refer the patient to an appropriate specialist.
If you have any queries about certifying a patient’s fitness to drive, contact Medisec for advice.
References:1The 2016 Edition of Sláinte & Tiomáint was published in April and is available on www.ndls.ie.