Assessing Fitness To Drive May 2022

Assessing fitness to drive
– a guide for medical professionals
www.gov.uk/dvla/fitnesstodrive
May 2022
High level changes
Chapter 1
Clarification of medical standard for cranioplasty
Chapter 2
Aortic aneurysm (including bicuspid aortopathy, aortic dissection, Marfan Syndrome
and other inherited aortopathies) – clarification of standards
Hypertrophic cardiomyopathy – interpretation of ECG changes during exercise testing
(Appendix C)
Congenital heart disease – referencing of classification of complexity of congenital
heart disease
Chapter 3
Clarification of medical standard for diabetes managed by medication other than insulin
Clarification of medical standard for severe hypoglycaemia due to causes other than
diabetes management
Chapter 4
“Acute Psychotic disorder” renamed to “Psychotic disorder – including acute episode”
“Mild cognitive impairment (not mild dementia)” renamed to “Cognitive impairment
(not mild dementia)”
Mild-moderate anxiety or depression no longer requires notification for
Group 2 licensing
Severe anxiety or depression – period of stability required for Group 1 licensing clarified
Behaviour Disorders – clarification of standard
Personality Disorders – clarification of standard
Chapter 5
Clarification of methadone/buprenorphine treatment programme standards
Contents
Introduction ................................................................................................................................................... 4
General information ............................................................................................................................... 6
Chapter 1
Neurological disorders ...................................................................................................................... 16
Chapter 2
Cardiovascular disorders ................................................................................................................ 50
Chapter 3
Diabetes mellitus ................................................................................................................................... 72
Chapter 4
Psychiatric disorders ......................................................................................................................... 81
Chapter 5
Drug or alcohol misuse or dependence ............................................................................ 90
Chapter 6
Visual disorders ...................................................................................................................................... 98
Chapter 7
Renal and respiratory disorders ............................................................................................ 106
Chapter 8
Miscellaneous conditions ............................................................................................................ 109
Appendix A: The legal basis for the medical standards ................................ 117
Appendix B: Epilepsy and seizure rules and further guidance ................ 118
Appendix C: Cardiovascular considerations ............................................................. 123
Appendix D: INF188/2 leaflet ‘Information for
drivers with diabetes’ and INF294 leaflet
‘A guide to insulin treated diabetes and driving’ ................. 127
Appendix E: Important notes concerning
psychiatric disorders .................................................................................... 128
Appendix F: Disabilities and vehicle adaptations ................................................. 130
Appendix G: Mobility Centres and
Driving Assessment Centres .................................................................. 131
Index .............................................................................................................................................................. 132
Intro
Introduction
Introduction
The impact of medical conditions on driving
Driving involves a complex and rapidly repeating cycle that requires a level of skill and
the ability to interact simultaneously with both the vehicle and the external environment.
Information about the environment is via the visual and auditory senses and is acted on
by many cognitive processes (including short-and long-term memory, and judgement)
to affect decisions for the driving task in hand. These decisions are enacted by the
musculoskeletal system, which acts on the controls of the vehicle and its relation to
the road and other users.
The whole process is coordinated by complex interactions involving behaviour, strategic
and tactical abilities, and personality. In the face of illness or disability, adaptive strategies
are important for maintaining safe driving.
Safe driving requires, among other elements, the involvement of:
■ vision
■ visuospatial perception
■ attention and concentration
■ memory
■ insight and understanding
■ judgement
■ adaptive strategies
■ good reaction time
■ planning and organisation
■ ability to self-monitor
■ sensation
■ muscle power and control
■ coordination
Given these requirements, it follows that many body systems need to be functional for safe
driving – and injury or disease may affect any one or more of these abilities. Notwithstanding
this, many short term conditions do not require notification to DVLA.
The guidelines and their development

The drivers’ medical section within DVLA deals with all aspects of driver licensing when
there are medical conditions that impact, or potentially impact, on safe control of a vehicle.
To do this, DVLA develops and works within guidance, and this publication summarises
the national medical guidelines on fitness to drive. It is intended to assist doctors and other
healthcare professionals in advising their patients:
■ whether or not DVLA requires notification of a medical condition
■ what the licensing outcome from DVLA’s medical enquiries is likely to be
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Intro
Introduction
Some of the guidelines – for example, those around diabetes mellitus, epilepsy and vision
– are set against legislative requirements (see Appendix A, page 117 for details) but others
are the result of advice from the 6 Honorary Medical Advisory Panels to the Secretary of
State, which cover:
■ cardiology
■ neurology
■ diabetes
■ vision
■ alcohol or substance misuse and dependence

■ psychiatry
Each panel consists of acknowledged experts in the relevant area and includes DVLA and
lay membership. The panels meet biannually and, between meetings, give continual advice
to the Secretary of State and DVLA.
The medical standards are continually reviewed and updated when indicated in light of
recent developments in medicine generally, and traffic medicine in particular. The most
up-to-date version of this guide will always be online on GOV.UK
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Info
General
information
GB driver licensing ................................................................................................................. 7
Sudden disabling events ..................................................................................................... 8
DVLA notification by drivers or healthcare professionals .................................... 9
How DVLA responds to notification and applies the
medical standards ............................................................................................................... 12
Obtaining advice from DVLA on fitness to drive ................................................... 15
Seat belt use and exemption ......................................................................................... 15
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General information
Info
General information
GB driver licensing
Licensing and licence groups
The GB medical standards for driver licensing refer to Group 1 and Group 2 licence holders:
■ Group 1 includes cars and motorcycles
■ Group 2 includes large lorries (category C) and buses (category D)
In most cases, the medical standards for Group 2 drivers are substantially higher than for
Group 1 drivers. This is because of the size and weight of the vehicle and the length of time
an occupational driver typically spends at the wheel.
Drivers who were awarded a Group 1 category B (motor car) licence before 1st January
1997 have additional entitlement to categories C1 (medium-sized lorries, 3.5t to 7.5t) and
D1 (minibuses, 9 to 16 seats, not for hire or reward). Drivers with this entitlement retain it
only until their licence expires or it is revoked for medical reasons. On subsequent renewal
or reapplication, the higher medical standards applicable to Group 2 will apply.
Under certain circumstances, volunteer drivers may drive a minibus of up to 16 seats
without category D1 entitlement. DVLA outlines the rules for such circumstances on
the GOV.UK website (see Driving a minibus).
Age limits for licensing

Group 1
Licences are normally valid until 70 years of age (the ’til 70 licence) unless restricted to a
shorter duration for medical reasons.
There is no upper age limit to licensing, but after 70 renewal is required every 3 years.
A person in receipt of the mobility component of Personal Independence Payment (PIP)
can hold a driving licence from 16 years of age. (A person can’t apply for PIP until their
16th birthday.)
Group 2
The minimum age for Group 2 entitlement to drive lorries (category C) is 21 and for buses
(category D) is 24, unless the driver is undergoing or has passed the Driver Certificate
of Competence (CPC) initial qualification which they can do at the age of 21. The Group
2 licensing entitlement is valid for a maximum of 5 years. New applicants for a Group 2
licence are required to have a D4 medical examination completed by a registered medical
practitioner. Drivers under the age of 45 are required to renew their Group 2 licence every
5 years by way of self-declaration.
When a Group 2 driver reaches the age of 45, their licence will expire and they will need to
have a D4 medical examination. Drivers above the age of 45 will need to renew their driving
licence every 5 years and will need to have a D4 medical examination each time they renew.
Once a Group 2 driver reaches the age of 65, they need to renew their licence and have a
D4 medical examination every year.
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General information
Info
Group 2 drivers must notify DVLA if they develop a notifiable medical condition. Shorter
duration licences may be issued for medical reasons.
There are exceptions, such as driving in the armed forces, and people of a minimum age
of 18 can drive lorries and buses after gaining, or training towards, the Driver CPC.
Police, fire, ambulance and health service driver licensing

The same medical standards apply for drivers of police, fire, coastguard, ambulance
and health service vehicles as they do for all drivers holding Group 1 and 2 licences.
Any responsibility for determining higher medical standards, over and above these
licensing requirements, rests with the individual force, service or other relevant body.
Taxi licensing
Responsibility for determining any higher standards and medical requirements for taxi
drivers, over and above the driver licensing requirements, rests with Transport for London in
the Metropolitan area, or the local council in all other areas.
Decisions taken by employers on the use and application of the GB standards on fitness to
drive in particular circumstances and as they relate to employees are for the employer to
make. Any responsibility for determining higher medical standards, over and above these
licensing requirements, rests with the individual force, service or other relevant body.
Interpretation of GB legislation
The advice of the Honorary Medical Advisory Panels on the interpretation of GB legislation
and its appropriate application is made within the context of driver licensing.
Sudden disabling events

Anyone with a medical condition likely to cause a sudden disabling event at the wheel, or
who is unable to control their vehicle safely for any other reason, must not drive.
DVLA defines the risk of a sudden disabling event as:
■ 20% likelihood of an event in 1 year for Group 1 licensing
■ 2% likelihood of an event in 1 year for Group 2 licensing
These figures, while originally defined by older studies, have since been revalidated by more
recent risk-of-harm calculations.
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General information
Info
DVLA notification by drivers or healthcare professionals
Applicants and licence holders have a legal duty to:
■ notify DVLA of any injury or illness that would have a likely impact on safe driving ability
(except some short-term conditions that are unlikely to continue beyond 3 months, as
set out in this guide)
■ respond fully and accurately to any requests for information from either DVLA or
healthcare professionals
■ comply with the requirements of the issued licence, including any periodic medical
reviews indicated by DVLA
They should also adhere, with ongoing consideration of fitness to drive, to prescribed
medical treatment, and to monitor and manage the condition and any adaptations.
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 DVLA of any relevant condition
■ notify DVLA directly of an individual’s medical condition or fitness to drive, where they
cannot or will not notify DVLA themselves
In law, it is the duty of the licence holder or applicant to notify DVLA of any medical condition
that may affect safe driving. Individuals from Scotland, Wales and England can notify via
GOV.UK – see Medical conditions, disabilities and driving.
Individuals living in Northern Ireland can notify on the www.nidirect.gov.uk page on
How to tell DVA about a medical condition.
Circumstances may arise in which a person cannot or will not notify DVLA. It may be
necessary for a doctor, optometrist or other healthcare professional to consider notifying
DVLA under such circumstances if there is concern for road safety, which would be for both
the individual and the wider public.
The General Medical Council (GMC) and the General Optical Council (GOC) offer clear
guidance about notifying the DVLA when the person cannot or will not exercise their own
legal duty to do so.
The GMC guidelines 2017 (reproduced with permission) state:
1. In our guidance Confidentiality: good practice in handling patient information we say:
1. Trust is an essential part of the doctor-patient relationship and confidentiality
is central to this. Patients may avoid seeking medical help, or may under-report
symptoms, if they think that their personal information will be disclosed by doctors
without consent, or without the chance to have some control over the timing or
amount of information shared.
60. Doctors owe a duty of confidentiality to their patients, but they also have a wider
duty to protect and promote the health of patients and the public.
62. You should ask for a patient’s consent to disclose information for the protection of
others unless it is not safe or practicable to do so,1 or the information is required by
law. You should consider any reasons given for refusal.
64. If it is not practicable to seek consent, and in exceptional cases where a patient
has refused consent, disclosing personal information may be justified in the public
interest if failure to do so may expose others to a risk of death or serious harm.
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General information
Info
The benefits to an individual or to society of the disclosure must outweigh both the
patient’s and the public interest in keeping the information confidential.
68. If you consider that failure to disclose the information would leave individuals or
society exposed to a risk so serious that it outweighs patients’ and the public interest
in maintaining confidentiality, you should disclose relevant information promptly to
an appropriate person or authority. You should inform the patient before disclosing
the information, if it is practicable and safe to do so, even if you intend to disclose
without their consent.
About this guidance
2. Doctors owe a duty of confidentiality to their patients, but they also have a wider duty to
protect and promote the health of patients and the public.2 This explanatory guidance
sets out the steps doctors should take if a patient’s failure or refusal to stop driving
exposes others to a risk of death or serious harm.
Fitness to drive: doctors’ and patients’ responsibilities
3. The Driver and Vehicle Licensing Agency (DVLA) in England, Scotland and Wales and the
Driver and Vehicle Agency (DVA) in Northern Ireland are legally responsible for deciding
if a person is medically unfit to drive. This means they need to know if a person holding a
driving licence has a condition or is undergoing treatment that may now, or in the future,
affect their safety as a driver.
4. The driver is legally responsible for telling the DVLA or DVA about any such condition
or treatment. Doctors should therefore alert patients to conditions and treatments that
might affect their ability to drive and remind them of their duty to tell the appropriate
agency. Doctors may, however, need to make a decision about whether to disclose
relevant information without consent to the DVLA or DVA in the public interest if a
patient is unfit to drive but continues to do so.
Assessing a patient’s fitness to drive
5. When diagnosing a patient’s condition, or providing or arranging treatment, you
should consider whether the condition or treatment may affect their ability to drive safely.
You should:
refer to the DVLA’s guidance Assessing fitness to drive – a guide for medical
■
professionals 4, which includes information about disorders and conditions that can
impair a patient’s fitness to drive
seek the advice of an experienced colleague or the DVLA’s or DVA’s medical adviser
■
if you are not sure whether a condition or treatment might affect a patient’s fitness
to drive5.
Reporting concerns to the DVLA or DVA
6. If a patient has a condition or is undergoing treatment that could impair their fitness to
drive, you should:
a. explain this to the patient and tell them that they have a legal duty to inform the DVLA
or DVA
b. tell the patient that you may be obliged to disclose relevant medical information about
them, in confidence, to the DVLA or DVA if they continue to drive when they are not fit
to do so
c. make a note of any advice you have given to a patient about their fitness to drive in
their medical record.
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General information
Info
7. If a patient is incapable of understanding this advice – for example, because of dementia
– you should inform the DVLA or DVA as soon as practicable.
8. If a patient refuses to accept the diagnosis, or the effect of the condition or treatment on
their ability to drive, you can suggest that they seek a second opinion, and help arrange
for them to do so. You should advise the patient not to drive in the meantime. As long as
the patient agrees, you may discuss your concerns with their relatives, friends or carers.
9. If you become aware that a patient is continuing to drive when they may not be fit to
do so, you should make every reasonable effort to persuade them to stop. If you do not
manage to persuade the patient to stop driving, or you discover that they are continuing
to drive against your advice, you should consider whether the patient’s refusal to stop
driving leaves others exposed to a risk of death or serious harm. If you believe that it
does, you should contact the DVLA or DVA promptly and disclose any relevant medical
information, in confidence, to the medical adviser.
10. Before contacting the DVLA or DVA, you should try to inform the patient of your
intention to disclose personal information. If the patient objects to the disclosure, you
should consider any reasons they give for objecting. If you decide to contact the DVLA
or DVA, you should tell your patient in writing once you have done so, and make a note
on the patient’s record.
Responding to requests for information from the DVLA or the DVA
11. If you agree to prepare a report or complete or sign a document to assist the DVLA’s
or the DVA’s assessment of a patient’s fitness to drive, you should do so without
unreasonable delay.
See the full guidance at the GMC website, Confidentiality: patients’ fitness to drive and
reporting concerns to the DVLA or DVA (2017).
The GOC offers similar guidance, available in full at its website under the confidentiality
section of its General Optical Council Standards (use the subsection on ‘disclosing
confidential information about patients with or without consent’).
This guidance includes the following (reproduced with permission of GOC):
Disclosing information with consent

Where you are not sharing information with other healthcare professionals for the purpose of
providing (or supporting the provision of) direct care to a patient, you should always try
to get your patient’s explicit consent to disclose sensitive information about them, unless
any of the following apply:
a. obtaining consent would defeat the purpose of the disclosure (for example, where
there would be a risk of harm to others; where detection of a serious crime would be
obstructed); or
b. you have already made the decision to disclose information in the public interest and
obtaining consent would be meaningless or tokenistic; or
c. the patient is not able to give consent as a result of disability, illness or injury. A
patient’s ability to give consent is referred to as their ‘capacity’ to consent. For more
information on capacity, including what to do if a patient lacks capacity, see our
consent guidance.
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General information
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Where your patient provides you with explicit consent to disclose confidential information
about them, you must ensure that they know what they are consenting to (see Standards
2 and 3 of the Standards of Practice, and our consent guidance) and that they are clear
what information is going to be disclosed, why it is being disclosed and to which person
or authority. Where you are relying on implied consent (see paragraph 10 above), patients
should not be surprised to learn how their information is used; if the information would be
used in ways that patients would not reasonably expect, you should seek explicit consent
for this from the patient.
It is important to remember that patients with the capacity to consent have the right to
make their own decisions and to refuse consent, even where you or others may consider
the decision to be ill-advised. If a patient makes a decision contrary to clinical advice,
you should document this in the patient records so that it is clear to all involved in that
patient’s care.
Disclosing information without consent

If a patient does not provide you with explicit consent to disclose confidential information
about them, and if you cannot rely on implied consent, there may still be circumstances in
which you may pass the information on to an appropriate authority, such as where it is in the
public interest, or where there is a legal requirement for you to do so.
Notification can be provided by healthcare professionals in the above circumstances,
in confidence:
[email protected]
Telephone: 01792 782337
Medical Business Support
D7 West
DVLA
Swansea
SA6 7JL
How DVLA responds to notification and applies the

medical standards
Once DVLA is notified of a medical condition and obtains consent, it will make medical
enquiries as required.
DVLA is unable to make a licensing decision until all the relevant medical information is
available and has been considered. Exceptions to this do exist, specifically DVLA’s ability
to revoke a licence immediately in the interests of road safety and without detailed enquiry
if individual case circumstances dictate this.
DVLA’s medical enquiries procedure is generally a 2-stage process:
1. Information on the medical condition is sought from the licence holder or applicant,
either by paper questionnaire or online
2. Information is sought from relevant healthcare professionals, either by questionnaire or
provision of medical notes.
In some circumstances DVLA will require independent review by a DVLA-appointed doctor
or optician/optometrist. Depending on individual circumstances, a licence applicant may
also require a driving assessment and/or appraisal.
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General information
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Driving during medical enquiries
It is for individuals to assure themselves that they are fit to drive. The doctor in charge of
an individual’s care should be able to advise them if it is safe to continue driving while the
DVLA conducts medical enquiries.
Individuals must be reminded that if they choose to ignore medical advice to stop driving,
this may affect their motor insurance cover. Doctors should document the advice they give
formally and clearly.
The DVLA is reliant on doctors and other healthcare professionals to provide medical
information on their patients as quickly as possible. When the DVLA has all the relevant
information, a decision can be made on whether an individual satisfies the standards for
a licence to be issued, or whether a licence must be revoked or an application refused.
It can take some time to obtain the necessary reports and complete medical enquiries,
but drivers may be able to continue driving under section 88 of the Road Traffic Act 1988.
This section allows those who have submitted a valid application to continue driving
while waiting for their application to be processed, providing they can meet strict criteria.
Individuals may only drive if they meet all the criteria specified within the section.
The DVLA cannot give definitive advice on whether individuals may drive under section 88.
The guidance leaflet INF188/6 provides a summary of the criteria within section 88 and
drivers should be directed to this if they have any queries:
www.gov.uk/government/publications/inf1886-can-i-drive-while-my-application-is-with-dvla
Outcome of medical enquiries

DVLA does not routinely tell doctors of the outcome of a medical enquiry. Drivers are
always informed of the outcome, either by being issued a licence or by notification of a refusal
or revocation.
For cases in which the driver may not have the insight and/or memory function to abide by
the refusal or revocation of their licence – for example, in cognitive impairment, dementia or
a mental health condition – DVLA would usually send a decision letter to the GP.
When a notification is received from a doctor in accordance with the GMC guidelines,
unless relevant to one of these conditions affecting mental capacity, DVLA will send an
acknowledgement letter only to the GP, to confirm receipt of the original notification.
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General information
Info
Medical notification form for use by healthcare professionals
The medical notification form for use when patients cannot or will not notify DVLA
themselves is available, for use by healthcare professionals only, on GOV.UK. This form
is only for patients living in England, Scotland or Wales who hold a driving licence issued
by DVLA.
The completed form should be returned to:
[email protected]
Medical Business Support
D7 West
DVLA
Swansea
SA6 7JL
For patients living in Northern Ireland who cannot or will not self-notify, please use these
contact details:
[email protected]
Telephone: 0300 200 7861
Drivers Medical Section
Driver and Vehicle Agency
Castlerock Road
Waterside
Coleraine
BT51 3TB
Please fill in all parts of DVLA’s medical notification form in relation to the medical condition
of your patient. Parts A and B are for your patient’s and your own details,
including your signed and dated declaration that all details are correct to the best
of your knowledge.
Part C of the form should be completed in all fields and providing as much detail as
possible regarding your patient’s medical condition. You may send clinic letters with this
notification, to help provide details of your patient’s medical condition or if you think it will
aid the licensing decision.
Please note, your patient can request copies of any medical documents held at DVLA
unless you specify in writing that releasing this information could cause serious harm
to your patient.
DVLA do not pay any fees for notifications.
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General information
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Obtaining advice from DVLA on fitness to drive
Contacting DVLA’s doctors
Doctors and other healthcare professionals are always welcome to write, email or speak
(by telephone between 10.30am and 1pm from Monday to Friday) to one of DVLA’s
doctors.
Advice may be sought about a particular driver identified by a unique reference number, or
about fitness to drive in general.
If the telephone service is busy, you will be able to leave a message for one of the DVLA
doctors to call back.
The contact details for such enquiries in England, Scotland and Wales are:
[email protected]
Telephone: 01792 782337
Fax: 01792 761104
The Medical Adviser
Drivers Medical Group
DVLA
Swansea
SA99 1DA
Please note that this service is for medical professionals only.
The contact details for enquiries in Northern Ireland are:
Telephone: 0300 200 7861
Drivers Medical Section
Driver and Vehicle Agency
Castlerock Road
Waterside
Coleraine
BT51 3TB
Seat belt use and exemption

The law makes it compulsory for car occupants to wear seatbelts where fixed. Exemption
on medical grounds requires a valid exemption certificate to confirm that, in a medical
practitioner’s view, exemption is justified. Exemption will require careful consideration in
view of extensive evidence for the safety implications of seatbelts in reducing casualty rates.
The guidance leaflet ‘Medical exemption from compulsory seat belt wearing’ is on GOV.UK.
15 Contents
Must not drive Might be allowed to drive subject to May drive and need
medical advice and/or notifying DVLA not notify DVLA
01
01 Neurological
disorders
Serious neurological disorders ......................................................................................
Epilepsy and seizures ........................................................................................................
17
18
Transient loss of consciousness (‘blackouts’) ....................................................... 21
Cough syncope ..................................................................................................................... 26
Primary/central hypersomnias ...................................................................................... 27
Chronic neurological disorders ..................................................................................... 27
Parkinson’s disease ............................................................................................................ 28
Dizziness .................................................................................................................................. 28
Stroke, transient ischaemic attack (TIA) and
cerebral venous thrombosis ........................................................................................... 29
Visual inattention ................................................................................................................. 30
Carotid artery stenosis ...................................................................................................... 30
Acute encephalitic illness and meningitis ............................................................... 30
Transient global amnesia ................................................................................................. 31
Arachnoid cysts .................................................................................................................... 31
Colloid cysts ........................................................................................................................... 31
Pituitary tumour .................................................................................................................... 32
Benign brain tumours ........................................................................................................ 32
Malignant brain tumours .................................................................................................. 34
Acoustic neuroma/schwannoma ................................................................................. 37
Brain biopsy ........................................................................................................................... 37
Traumatic brain injury ....................................................................................................... 37
Subdural haematoma ........................................................................................................ 38
Subarachnoid haemorrhage ........................................................................................... 39
Intracranial aneurysm ....................................................................................................... 41
Arteriovenous malformation (AVM) ............................................................................. 42
Dural arteriovenous fistula .............................................................................................. 44
Cavernous malformation .................................................................................................. 44
Intracerebral abscess/subdural empyema .............................................................. 46
Cranioplasty ........................................................................................................................... 47
Chiari malformation ............................................................................................................ 47
Surgical treatment/foramen magnum decompression ..................................... 47
Hydrocephalus ...................................................................................................................... 48
Intaventricular shunt or extraventricular drain ...................................................... 48
Neuroendoscopic procedures ........................................................................................ 48
Intracranial pressure monitoring device ................................................................... 49
Implanted electrodes ......................................................................................................... 49
16 Contents
Chapter 01: Neurological disorders
01
Serious neurological disorders
Changes to Annex III to the EC Directive 2006/126/EC require that driving licences may not
be issued to, or renewed for, applicants or drivers who have a serious neurological disorder
unless there is medical support from their doctors.
A serious neurological disorder is considered as:
■ any condition of the central or peripheral nervous system presently with, or at risk of
progression to a condition with, functional (sensory (including special senses), motor
and/or cognitive) effects likely to impact on safe driving
Further information relating to specific functional criteria is provided on:
■ specific neurological conditions in this chapter (Neurology)
■ cognitive and related conditions in Chapter 4
■ visual conditions and disorders in Chapter 6
■ excessive sleepiness in Chapter 8
When considering licensing for these customers, the functional status and risk of
progression will be considered. A short term medical review licence is generally issued
when there is a risk of progression.
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01
Epilepsy and seizures
Appendix B, page 117 sets out the relevant regulations.
The following definitions apply:

■
epilepsy encompasses all seizure types, including major, minor and auras
■
if within a 24-hour period more than one epileptic event occurs, these are treated
as a single event for the purpose of applying the epilepsy and seizure regulations
■ from a licensing perspective, epilepsy means 2 or more unprovoked seizures over a
period which exceeds 24 hours
■ epilepsy is prescribed in legislation as a relevant disability where there have been 2
or more epileptic seizures during the previous 5 year period
■ isolated seizure means one or more unprovoked seizures within a 24 hour period,
or one or more unprovoked seizures within a 24 hour period where that period of
seizure has occurred more than 5 years after the last unprovoked seizure
The following features, in both Group 1 car and motorcycle and Group 2 bus and lorry
drivers, are considered to indicate a good prognosis for a person under care for a first
unprovoked or isolated epileptic seizure:
■ no relevant structural abnormalities on brain imaging
■ no definite epileptiform activity on EEG
■ support of a neurologist
■ annual risk of seizure considered to be 2% or lower for bus and lorry drivers
Group 1 Group 2
car and motorcycle bus and lorry
Epilepsy or multiple Must not drive and must Must not drive and must
unprovoked seizures notify DVLA. notify DVLA.
Driving must cease for 12 months from The person with epilepsy must remain
the date of the most recent seizure, seizure-free for 10 years (without
unless the seizure meets legal criteria epilepsy medication) before licensing
to be considered as a permitted may be considered.
seizure (see Appendix B).
First unprovoked Must not drive and must Must not drive and must
epileptic seizure/ notify DVLA. notify DVLA.
isolated seizure Driving must cease 5 years from the
Driving must cease 6 months from the
date of the seizure, or for 12 months if date of the seizure.
there is an underlying causative factor If, after 5 years, a neurologist has made
that may increase risk. a recent assessment and clinical factors
or investigation results (for example,
EEG or brain scan) indicate no annual
risk greater than 2% of a further seizure,
the licence may be restored.
Such licensing also requires that
there has been no need for epilepsy
medication throughout the 5 years up to
the date of the licence being restored.
continued
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01
Group 1 Group 2
Withdrawal of See the special considerations below, and Appendix B, page 118 gives full
epilepsy medication guidance on withdrawing epilepsy medication.
Provoked seizures Must not drive and must notify Must not drive and must notify
(except related to use
DVLA. In most cases driving must DVLA. Driving must cease for up to
of alcohol or illicit drugs) cease for 6 months after the provoked 5 years after the provoked seizure.
seizure. See the special considerations See the special considerations in
in Appendix B and Provoked seizures. Appendix B and Provoked seizures.
Dissociative seizures Must not drive and must Must not drive and must
notify DVLA. notify DVLA.
Licensing may be considered when the Licensing may be considered once
driver or applicant has been event free episodes have been satisfactorily
for 3 months. If episodes have occurred controlled for 3 months and there are
or are considered likely to occur whilst no relevant mental health issues. If
driving, a specialist’s review would also high risk features, a specialist’s review
be required prior to licensing. would be required prior to relicensing.
continued
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01
Special considerations
Group 1 car and motorcycle
The following special considerations apply to drivers of cars and motorcycles:
1. The person with epilepsy may qualify for a driving licence if they have been free from
any seizure for 1 year. This needs to include being free of minor seizures, including
those that do not involve a loss of consciousness, and epilepsy signs such as limb
jerking, auras and absences.
2. The person who has had a seizure while asleep must stop driving for 1 year from the
date of the seizure unless point 3 or 5 apply.
3. Relicensing may be granted if the person, over the course of at least 1 year from the
date of the first sleep seizure, establishes a history or pattern of seizures occurring
only ever while asleep.
4. Relicensing may be granted if the person, over the course of at least 1 year from
the date of the first seizure, establishes a history or pattern of seizures which affect
neither consciousness nor cause any functional impairment. The person must never
have experienced any other type of unprovoked seizure.
5. Regardless of preceding seizure history, if a person establishes a pattern of asleep
seizures only (all seizures had onset during sleep), starting at least 3 years prior
to licence application and there have been no other unprovoked seizures during those
3 years, a licence may be issued.
Overriding all of the above considerations is that the licence holder or applicant with
epilepsy must not be regarded as a likely source of danger to the public while driving and
that they are compliant with their treatment and follow up.
If the licensed driver has any epileptic seizure, they must stop driving immediately unless
DVLA has established that considerations 3, 4 or 5 can be met, and they must notify DVLA.
If a licence is issued under considerations 3, 4 or 5 and the driver has a different type
of seizure, they lose the concession, must stop driving, and must notify DVLA.
Isolated seizures
An isolated seizure is an unprovoked seizure experienced by a person who has not had
any other unprovoked seizures during the preceding 5 years. A person who has an isolated
seizure will qualify for a driving licence if they are free from any further seizure for 6 months,
unless there are clinical factors or results of investigations suggesting an underlying
causative factor that may increase the risk of a further seizure, in which case 12 months is
required before relicensing.
Withdrawal of epilepsy medication (see page 121 and also appendix on page 118)
Individuals should not drive whilst anti-epilepsy medication is being withdrawn and for
6 months after the last dose.
For a driver with epilepsy, if a seizure occurs within 6 months of, and because of
a documented physician-advised substitution, reduction or withdrawal of anti-epilepsy
medication, the regulations allow relicensing prior to the usual 12 month post-seizure
period. Earlier relicensing may be considered if previously effective medication has
been reinstated for at least 6 months and the driver has remained seizure free for at least
6 months.
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01
Group 2 bus and lorry
Drivers of buses and lorries must satisfy all of the following conditions under the regulations.
They must:
■ hold a full ordinary driving licence
■ have been free of epileptic seizures for the last 10 years
■ not have taken any medication to treat epilepsy during these 10 years (there are thus
no special considerations for withdrawal)
■ have no continuing increased risk of epileptic seizures
■ not be a source of danger whilst driving
Isolated seizure
Drivers of buses and lorries must satisfy all of the following conditions in relation to an
isolated seizure. They must:
■ hold a full ordinary driving licence
■ have been free of epileptic attacks for the last 5 years
■ not have taken any medication to treat epilepsy or a seizure during these 5 years
■ have undergone a recent assessment by a neurologist
■ have no continuing increased risk of seizures
Transient loss of consciousness (‘blackouts’)

– or lost/altered awareness
Transient loss of consciousness (TLoC) or ‘blackout’ is very common – it affects up
to half the population in the UK at some point in their lives. An estimated 3% of A&E
presentations and 1% of hospital admissions are due to TLoC.
Road traffic collisions resulting from blackouts are two or three times more common than
those resulting from seizures.
Recurrent TLoC (more than one isolated event), not including syncope, is uncommon –
but always requires detailed medical assessment.
There are several causes of transient loss of consciousness:
Syncope See pages 23-26 of this chapter
Seizure/epilepsy See pages 18-20 of this chapter
Hypoglycaemia See page 72 for Chapter 3 (diabetes mellitus)
See page 90 for Chapter 5

Drug/alcohol
(drugs or alcohol misuse or dependence)
See page 109, ‘excessive sleepiness’
Sleep disorders
in Chapter 8 (miscellaneous)
Undetermined See pages 23-26 of this chapter, ‘syncope’
See page 116, ‘medication effects’

Medication
in Chapter 8 (miscellaneous)
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01
In relation to TLoC, 3 features are of note to medical practitioners:
■ provocation
■ posture
■ prodrome
In relation to road safety, however, the 2 most important features are:

■ prodrome – are there warning symptoms sufficient in both nature and duration?
■ posture – do the episodes of TLoC occur while sitting?
A prodrome must allow time for a driver to find a safe place to stop before losing
consciousness. A prodrome is reliable if the signs are clear, consistent across all events
and provide sufficient duration to find a safe stop, or unreliable if these are absent.
Licence holders or applicants should be informed that they must notify DVLA
when TLoC occurs while sitting.
For syncope occurring while standing or sitting, the following factors indicate high risk:
■ abnormal ECG
■ clinical evidence of structural heart disease
Further investigations such as 48-hour ambulatory ECG, echocardiography and
exercise testing may be indicated after specialist opinion has been sought.
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01
Transient loss of consciousness – solitary episode
Group 1 Group 2
Typical vasovagal syncope
While standing May drive and need not Must not drive and must
While sitting May drive and need not notify Must not drive for 3 months
DVLA if there is an avoidable trigger and must notify DVLA. Will require
which will not occur whilst driving. investigation for identifiable and/or
Otherwise must not drive until treatable cause.
annual risk of recurrence is assessed
as below 20%.
Syncope with avoidable trigger or otherwise reversible cause

(for cough syncope see page 26)
While sitting Must not drive for 4 weeks. Must not drive for 3 months.
Driving may resume after 4 weeks Driving may resume after 3 months
only if the cause has been identified only if the cause has been identified
and treated. and treated.
Must notify DVLA if the cause has not Must notify DVLA if the cause has not
been identified and treated. been identified and treated.
Unexplained syncope, including syncope without reliable prodrome
This diagnosis may apply only after appropriate neurological and/or cardiological opinion
and investigations have detected no abnormality.
While standing or Must not drive and must Must not drive and must
sitting notify DVLA. notify DVLA.
If no cause has been identified, If no cause has been identified,
the licence will be refused or revoked the licence will be refused or revoked
for 6 months. for 12 months.
Cardiovascular, excluding typical syncope
Driving may be allowed to resume Driving may be allowed to resume
after 4 weeks if the cause has been after 3 months if the cause has been
identified and treated. identified and treated.
for 6 months. for 12 months.
continued
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01
Blackout with seizure markers
This category is for those where on the balance of probability there is clinical suspicion of
a seizure but no definite evidence. Individuals will require assessment by an appropriate
specialist and investigation, for example EEG and brain scan, where indicated.
The following factors indicate a likely seizure:
■ loss of consciousness for more than 5 minutes

■ amnesia longer than 5 minutes

■ injury

■ tongue biting

■ incontinence

■ post ictal confusion

■ headache post attack

While standing or Must stop driving and notify DVLA. Must stop driving and notify DVLA
sitting
6 months off driving from the date 5 years off driving from the date
of the episode. of the episode
If there are factors that may lead to an
increased risk of recurrence, 1 year off
driving would be required.
Transient loss of consciousness – recurring episodes

Recurrent episodes of TLoC are less common than isolated episodes but the
relevance to increased risk in driving cannot be overemphasised.
Recurrent TLoC is most commonly due to recurrent syncope, occurring in around 20% to
30% of patients. Recurrence of syncope is usually within 3 years of the first episode, and in
over 80% of these cases there has been at least one additional episode within 2 years of the
first episode.
In relation to road safety however, the 2 most important features of temporary loss
of consciousness are:
■ prodrome – are there warning signs sufficient in both nature and duration?
■ posture – do the episodes of TLoC occur while sitting?
A prodrome must allow time for a driver to find a safe place to stop before losing
consciousness. A prodrome is reliable if the signs are clear, consistent across all events
and provide sufficient duration to find a safe stop, or unreliable if these are absent.
Recurrent pre-syncopal events should be treated (from a licensing point of view) in the
same way as recurrent syncope, and should therefore be categorised according to the
standards for recurrent syncope.
Licence holders or applicants should be informed that they must notify DVLA
when transient loss of consciousness occurs while sitting.
continued
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01
Group 1 Group 2
Recurrent typical vasovagal syncope with identifiable consistent prodrome
While sitting May drive and need not notify Must not drive and must
DVLA if there is an avoidable trigger notify DVLA.
which will not occur whilst driving. Must not drive until annual risk of
Otherwise must not drive until annual recurrence is assessed as below 2%.
risk of recurrence is assessed as Will require investigation for identifiable
below 20%. and/or treatable cause.
Recurrent syncope with avoidable trigger or otherwise reversible cause

(for cough syncope see page 26)
While sitting Must not drive for 4 weeks. Must not drive for 3 months.
Must notify DVLA if the cause has not Must notify DVLA if the cause has not
been identified and treated. been identified and treated.
For syncope occurring while standing or sitting, the following factors indicate high risk:
■ abnormal ECG
■ clinical evidence of structural heart disease
Further investigations such as 48-hour ambulatory ECG, echocardiography and

exercise testing may be indicated after specialist opinion has been sought.
Group 1 Group 2
Recurrent unexplained syncope, including syncope without reliable prodrome
This diagnosis may apply only after appropriate neurological and/or cardiological opinion
and investigations have detected no abnormality.
for 12 months. for 10 years.
continued
25 Contents
Group 1 Group 2
01
Recurrent cardiovascular but excluding typical vasovagal syncope
If no cause has been identified, the If no cause has been identified, the
licence will be refused or revoked for licence will be refused or revoked for
12 months. 2 years.
Recurrent blackout with seizure markers
This category is for those where on the balance of probability there is clinical suspicion
of a seizure but no definite evidence. Individuals will require assessment by an appropriate
specialist and investigation, for example EEG and brain scan, where indicated.
While standing or Must stop driving and notify DVLA. Must stop driving and notify DVLA.
sitting
Depending on previous medical Depending on previous medical
history, the standards for isolated history, the standards for isolated
seizure or epilepsy will apply. seizure or epilepsy will apply.
Cough syncope
Having experienced an episode or episodes of cough syncope, a person has identified
themselves as being in a higher risk group that is predisposed to cough syncope. Therefore,
even if the cough syncope episode occurred during a short-lived period of increased cough
(such as an episode of acute respiratory infection), this would not alter the fact that the
person is then at a higher risk of experiencing an episode of cough syncope whenever they
cough, regardless of the cause. Treatment, management or resolution of the condition which
caused the cough does not reduce the risk of syncope with further episodes of cough.
Group 1 Group 2
Must not drive and must Must not drive and must
Must not drive for 6 months following Must not drive for 12 months following
a single episode and for 12 months a single episode and 5 years following
following multiple episodes over multiple episodes over 5 years.
5 years. If more than one episode of cough
If more than one episode of cough syncope occurs within a 24 hour
syncope occurs within a 24 hour period, this will be counted as a single
period, this will be counted as a single event. However if the episodes of
event. However if the episodes of cough syncope are more than 24 hours
cough syncope are more than 24 hours apart, these are considered as multiple
apart, these are considered as multiple episodes.
episodes.
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01
Primary/central hypersomnias
– including narcolepsy type 1 (narcolepsy with cataplexy)
and type 2
For other causes of excessive sleepiness, see Chapter 8 (miscellaneous conditions).
Group 1 Group 2
A licence may be reissued only when Relicensing may be considered subject
there has been satisfactory symptom to specialised assessment and a
control for at least 3 months before satisfactory objective assessment of
being considered for re-licensing. maintained wakefulness, such as the
When an applicant or licence holder Osler test.
is not on appropriate treatment, Must also satisfy standards as for
relicensing may be considered after Group 1 licensing.
satisfactory objective assessment of
maintained wakefulness, such as the
Osler test.
Chronic neurological disorders

– including multiple sclerosis and motor neurone disease
Any chronic neurological disorder that may affect vehicle control because of impaired
coordination and muscle strength.
For information on in-car driving assessments for those with a disability, see Appendix G
(page 131).
Group 1 Group 2
Must notify DVLA. Must notify DVLA.

May drive as long as safe vehicle May drive as long as safe vehicle
control is maintained at all times. control is maintained at all times.
A licence valid for 1, 2, 3 or 5 years A licence will be refused or revoked
may be issued provided medical if the individual’s condition is
enquiries by DVLA confirm that driving progressive or disabling.
performance is not impaired. If driving is not impaired and the
The licence may specify a restriction to underlying condition is stable, licensing
cars with certain controls. will be considered on an individual
basis subject to satisfactory medical
reports and annual review.
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01
Parkinson’s disease
Group 1 Group 2
Must notify DVLA. Must notify DVLA.

May drive as long as safe vehicle May drive as long as safe vehicle
control is maintained at all times. control is maintained at all times.
If the individual’s condition is disabling If the individual’s condition is disabling
and/or there is clinically significant and/or there is clinically significant
variability in motor function, the licence variability in motor function, the licence
will be refused or revoked. will be refused or revoked.
If driving is not impaired, licensing will If driving is not impaired, licensing will
be considered subject to satisfactory be considered subject to satisfactory
medical reports. A licence may be medical reports and assessment.
issued subject to regular review. A licence may be issued subject to
annual review.
Dizziness
– liability to sudden and unprovoked or
unprecipitated episodes of disabling dizziness
Sudden is defined as ‘without sufficient warning to allow safe evasive action when driving’
and disabling is defined as ‘unable to continue safely with the activity being performed’.
Group 1 Group 2
Must not drive on presentation Must not drive on presentation

and must notify DVLA. and must notify DVLA.
When satisfactory control of symptoms If there are sudden and disabling
has been achieved, relicensing may be symptoms, the licence will be refused
considered for restoration of the ’til 70 or revoked.
licence. If an underlying diagnosis is likely to
cause recurrence, the patient must
be asymptomatic and completely
controlled for 1 year from an episode
before reapplying for their licence.
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01
Stroke, transient ischaemic attack (TIA) and
cerebral venous thrombosis
– including amaurosis fugax and retinal artery occlusion
For Group 2 bus and lorry drivers, the guidance is the same whether concerning
stroke, or single or multiple transient ischaemic attack (TIA).
Group 1 Group 2
Stroke and cerebral Must not drive but may not need Must not drive and must
venous thrombosis to notify DVLA. notify DVLA.
Driving may resume after 1 month if A licence will be refused or revoked
there has been satisfactory clinical for 1 year following a stroke or TIA.
recovery. Relicensing after 1 year may be
DVLA does not need to be notified considered if:
unless there is residual neurological ■ there is no debarring residual
deficit 1 month after the episode and, impairment likely to affect safe
in particular: driving and
■ visual field defects ■ there are no other significant risk
■ cognitive defects factors
■ impaired limb function Licensing may be subject to a
satisfactory medical report, including
Minor limb weakness alone after a
results of exercise ECG testing.
stroke will not require notification to
DVLA unless restriction to certain If the condition is cerebral venous
types of vehicle or adapted controls thrombosis or there is imaging
may be needed. With adaptations, evidence of less than 50% carotid
severe physical impairment may not be artery stenosis and there is no
an obstacle to driving. previous history of cardiovascular
disease, a licence may be issued
Seizures occurring at the time of a
without the need for functional
stroke or TIA, or in the ensuing first
cardiac assessment.
week, may be treated as provoked
for licensing purposes, provided there Patients with recurrent TIAs or strokes
is no previous history of unprovoked will be required to undergo functional
seizure or cerebral pathology. cardiac testing.
Such provoked seizures will usually
necessitate driving cessation. See
Appendix B, page 118.
Single transient Must not drive for 1 month but

ischaemic need not notify DVLA.
attack
Multiple transient Must not drive and must

ischaemic attack notify DVLA.
Multiple TIAs over a short period
will require no driving for 3 months.
Driving may resume after 3 months if
there have been no further TIAs.
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01
Visual inattention
Group 1 Group 2
Must not drive and must notify DVLA.

Clinically apparent visual inattention is debarring for licensing.
Carotid artery stenosis

Group 1 Group 2
May drive and need not Should not drive unless, in the
notify DVLA. view of an appropriate healthcare
professional, it is safe to do so.
Must notify DVLA.
If the level of stenosis is severe enough
to warrant surgical or radiological
intervention, the requirements for
exercise or other functional test must
be met – see Appendix C, page 123.
Acute encephalitic illness and meningitis

– including limbic encephalitis associated with seizures
Group 1 Group 2
Must not drive and may need to Must not drive and may need to
If there are no seizures, driving may a. If there are no seizures, may resume
resume after complete clinical recovery driving after complete clinical
and DVLA need not be notified unless recovery and need not notify DVLA
there is residual disability. unless there is residual disability.
If associated with seizure(s) DVLA must b. If seizures occur DVLA must be
be notified and driving must cease. notified and will refuse or revoke a
a. If seizures occur during an acute licence until the seizure regulations
febrile illness, providing there is are met (see Appendix B, page 118).
no previous history of unprovoked
seizure or pre-existing cerebral
pathology, a licence will be revoked
or refused for 6 months.
b. If seizures occur during or after
convalescence, or if there is a
previous history of unprovoked
seizure or pre-existing cerebral
pathology, a licence will be refused
or revoked for 12 months (see
Appendix B).
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01
Transient global amnesia
Group 1 Group 2
May drive provided epilepsy, any Driving is not barred by a single

sequelae from head injury and other confirmed episode, and the licence
causes of altered awareness have may be retained.
been excluded. Driving should stop if 2 or more
DVLA does not need to be notified episodes occur, and DVLA must be
and a ’til 70 licence may be retained. notified. Specialist assessment will be
required to exclude all other causes of
altered awareness.
Arachnoid cysts
Group 1 Group 2
Asymptomatic May drive and need not May drive and need not
and no need for notify DVLA. notify DVLA.
treatment
Treated by Must not drive for 6 months and Must not drive and must
craniotomy and/or must notify DVLA. notify DVLA.
endoscopically Relicensing may be considered
after 2 years following treatment,
provided there is no debarring residual
impairment likely to affect safe driving.
Colloid cysts
Group 1 Group 2
Asymptomatic May drive and need not Must notify DVLA.

and no need for notify DVLA. May drive unless prophylactic
treatment medication for seizures is prescribed,
in which case an individual
assessment will be required.
Treated by Must not drive for 6 months and Must not drive and must
craniotomy and/or must notify DVLA. notify DVLA.
endoscopically Relicensing may be considered
after 2 years following treatment,
provided there is no debarring residual
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01
Pituitary tumour
Group 1 Group 2
Treated by Must not drive and must Must not drive and must
craniotomy notify DVLA. notify DVLA.
Driving may resume after 6 months Driving will remain prohibited for
provided there is no visual field defect. 2 years.
If there is visual field loss, see
Chapter 6, visual disorders.
No need for Must not drive but need not Must not drive but need not
treatment, or treated notify DVLA. notify DVLA.
by transsphenoidal Driving may resume on recovery Driving may resume on recovery
surgery or therapy provided there is no debarring visual provided there is no debarring visual
such as drugs or field defect. field defect.
radiotherapy
Benign brain tumours

Group 1 Group 2
Benign supratentorial non-parenchymal tumour (WHO grade I meningioma, for example)
Driving may resume after 6 months The licence will be refused or revoked.
provided there is no debarring residual In the absence of any seizures and
impairment likely to affect safe driving, with evidence of complete tumour
and no history of seizures. removal, relicensing may be
If the tumour has been associated considered 5 years after the surgery.
with seizures, driving must cease for If the tumour is associated with seizure,
12 months following surgery and relicensing will not be considered until
12 months from the date of the most 10 years after surgery, provided these
recent seizure. years are free from seizures without
epilepsy medication.
Specialist assessment may be required.
stereotactic notify DVLA. notify DVLA.
radiosurgery Driving may resume after 1 month The licence will be refused or revoked.
provided there is no debarring residual Provided there is evidence of stability
impairment likely to affect safe driving. on imaging, relicensing may be
The regulations (see Appendix B, considered 3 years from completion of
page 118) apply if there is relevant the primary tumour treatment.
seizure history. If the tumour is associated with seizure,
relicensing will not be considered until
10 years after surgery, provided these
years are free from seizures without
epilepsy medication.
continued
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01
fractionated notify DVLA. notify DVLA.
radiotherapy Driving may resume on completion The licence will be refused or revoked.
of treatment provided there is no Provided there is evidence of stability
debarring residual impairment likely on imaging, relicensing may be
to affect safe driving. considered 3 years from completion
The regulations (see Appendix B, of the primary tumour treatment.
page 118) apply if there is relevant If the tumour is associated with
seizure history. seizure, relicensing will not be
considered until 10 years after surgery,
provided these years are then free from
seizures without epilepsy medication.
WHO grade II meningiomas treated with craniotomy and/or radiosurgery

and/or radiotherapy
Driving may resume 1 year after The licence will be refused or revoked.
completion of treatment. In the absence of any seizures and
The regulations (see Appendix B, with evidence of complete tumour
page 118) apply if there is relevant removal, DVLA may consider
seizure history. relicensing 5 years after the surgery.
If the tumour is associated with seizure,
relicensing will not be considered until
10 years after surgery, provided these
years are then free from seizures
without epilepsy medication.
Asymptomatic incidental meningiomas not needing treatment
May drive and need not Must not drive and must
The licence will be refused or revoked.
Relicensing may be considered after
2 scans performed 12 months apart
show no growth.
Individual assessment will be
considered if such lack of growth
cannot be demonstrated.
Licences are reissued with
annual review.
Benign infratentorial tumours – for example, meningioma treated with craniotomy with
or without radiotherapy
May drive but need not notify DVLA. Must not drive and must
Driving may resume on recovery from notify DVLA.
treatment. Driving may resume on recovery from
treatment provided that there is no
debarring residual impairment likely
to affect safe driving.
continued
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01
Asymptomatic suspected low-grade tumour
There will be an individual assessment The licence will be refused or revoked.
for licensing with clear medical Driving must cease for 12 months but
evidence and any licence will relicensing may be considered after
initially be under regular, usually 2 scans performed 12 months apart
annual, review. confirm stability of the lesion.
Malignant brain tumours

– including metastatic deposits and pineal tumours
The standards will apply to first occurrence, recurrence and progression.
Supratentorial
Group 1 Group 2
WHO grade I or II Must not drive and must Must not drive and must
glioma notify DVLA. notify DVLA.
Driving must cease for 6 months The licence will be refused or revoked
following a biopsy, if there has been no permanently.
other treatment. Except grade I pineocytoma:
Driving may resume 1 year after relicensing may be considered on an
completion of primary treatment. individual basis 2 years after primary
Where there is imaging evidence of treatment, provided MRI imaging is
tumour recurrence or progression satisfactory.
licensing may be considered if:
■ there has been a 1 year seizure
free period
■ there is no clinical disease progression
■ no further primary treatment (with
the exception of chemotherapy) was

required for the recurrence.
If these criteria cannot be met, a
further 1 year off driving will be
required following completion of
primary treatment or following seizure.
A 1 year licence will usually be considered.
WHO grade III Must not drive and must Must not drive and must
meningioma notify DVLA. notify DVLA.
Driving may resume 2 years after the The licence will be refused or revoked
completion of primary treatment. permanently.
WHO grade III or IV Must not drive and must Must not drive and must
gliomas, metastatic notify DVLA. notify DVLA.
deposit(s), or primary
Driving may resume at least 2 years The licence will be refused or revoked
or secondary CNS
after the completion of primary permanently.
lymphoma treatment.
continued
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01
Solitary metastatic Must not drive and must Must not drive and must
deposit notify DVLA. notify DVLA.
Relicensing may be considered 1 year The licence will be refused or revoked
after completion of the primary treatment permanently.
provided there is no recurrence and
no evidence of disease progression
elsewhere in the body.
If these criteria cannot be met then
driving must cease for 2 years following
completion of primary treatment.
Metastatic brain Must not drive and must Must not drive and must
disease treated by notify DVLA. notify DVLA.
immunotherapy
For drivers with supratentorial The licence will be refused or revoked
or other targeted metastatic brain disease who permanently.
therapies have received or are receiving
immunotherapy or other molecular
targeted treatment, relicensing may be
considered one year after completion
of primary treatment (or one year after
commencement of the targeted therapy
if no other primary treatment for the
intracranial disease has been given) if
there is clinical and imaging evidence of
disease stability or improvement, with
no deterioration both intracranially and
elsewhere in the body.
If these criteria cannot be met driving
must cease for 2 years. This standard
can be applied both to isolated
metastasis and to a driver with multiple
brain metastases.
Infratentorial
Group 1 Group 2
WHO grade I glioma Must not drive and must Must not drive and must
Driving may resume on recovery. Relicensing will be considered on
individual assessment.
WHO grade II, III or Must not drive and must Must not drive and must
IV glioma notify DVLA. notify DVLA.
Driving may resume 1 year (grade II) The licence will be refused or revoked
or 2 years (grades III and IV) after the permanently.
completion of primary treatment.
continued
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01
Group 1 Group 2
Medulloblastoma, Must not drive and must Must not drive and must
low grade notify DVLA. notify DVLA.
ependymoma
Relicensing may be considered Relicensing may be considered
1 year after completion of the primary 5 years after completion of the primary
treatment if there was complete treatment, provided this period is clinically
excision, and provided there is no disease-free, the tumour was entirely
recurrence. infratentorial and completely excised.
High-grade Must not drive and must Must not drive and must
ependymoma, other notify DVLA. notify DVLA.
primary malignant
Relicensing may be considered The licence will be refused or revoked
brain tumour, or normally only after 2 years from permanently.
primary or secondary completion of the primary treatment.
CNS lymphoma
Brain metastases Must not drive and must Must not drive and must
Relicensing may be considered 1 year Relicensing may be considered
after completion of the primary treatment 5 years after completion of the
if the patient is otherwise well. primary treatment.
Metastatic brain Must not drive and must Must not drive and must
disease treated by notify DVLA. notify DVLA.
immunotherapy For drivers with infratentorial The licence will be revoked or refused
or other targeted metastatic brain disease who permanently.
therapies have received or are receiving
immunotherapy or other molecular
targeted treatment, relicensing
may be considered one year after
completion of primary treatment (or
one year after commencement of the
targeted therapy if no other primary
treatment for the intracranial disease
has been given) if there is clinical and
imaging evidence of disease stability
or improvement, with no deterioration
both intracranially and elsewhere in the
body. If these criteria cannot be met
driving must cease for 2 years.
This standard can be applied both to
isolated metastasis and to a driver with
multiple brain metastases.
Malignant May apply to drive (or continue to Must not drive and must
intracranial tumour drive) but must notify DVLA. notify DVLA.
in childhood A ’till 70 licence is normally granted or Licence may be granted or reissued
(supratentorial maintained. based on individual assessment.
and infratentorial):
survival without
recurrence
36 Contents
01
Acoustic neuroma/schwannoma
Group 1 Group 2
May drive and need not notify May drive and need not notify
DVLA unless there is sudden and DVLA unless there is sudden and
disabling giddiness. disabling giddiness and/or the
condition is bilateral.
Brain biopsy
Group 1 Group 2
Relicensing may be considered Relicensing may be considered after
after 6 months if the biopsy shows a minimum of 6 months depending
insignificant (from a licensing on individual assessment of the
perspective) histology and if there is underlying condition and if the biopsy
no debarring residual impairment likely shows insignificant (from a licensing
to affect safe driving. If a tumour is perspective) histology. If a tumour is
diagnosed on biopsy please refer to diagnosed on biopsy please refer to
the relevant tumour standard. the relevant tumour standard.
Traumatic brain injury

Group 1 Group 2
Must not drive but may need to Must not drive and must
Relicensing may be considered usually The licence will be refused or revoked.
after 6 to 12 months dependent on Drivers may be relicensed after the
features such as seizures, post-traumatic annual risk of seizure has fallen to
amnesia more than 24 hours, dural 2% or below and provided no debarring
tear, haematoma and/or contusions residual impairment is likely to affect
seen on CT imaging. safe driving.
There will need to have been satisfactory The Advisory Panel has suggested
clinical recovery and in particular that by five years, and sometimes after
no visual field defects or cognitive 2 or 3 years following a head injury,
impairment likely to affect safe driving. when there has been a full recovery
with no residual functional deficit likely
to affect safe driving, licensing can
usually be permitted for Group 2.
continued
37 Contents
01
Driving can resume on recovery and Relicensing can be reconsidered after
DVLA need not be notified if all of 3 months if all of the following can
the following can be satisfied: be satisfied:
■ there is full clinical recovery ■ there is full clinical recovery
■ there are no seizures (other than ■ there are no seizures (other than
an immediate seizure at the moment an immediate seizure at the moment
of impact) of impact)
■ there is no post traumatic amnesia ■ there is no post traumatic amnesia
lasting more than 24 hours lasting more than 24 hours
■ there is no intracranial haematoma ■ there is no intracranial haematoma
and/or contusions seen on CT and/or contusions seen on CT
imaging (a small traumatic imaging
subarachnoid haemorrhage in If there has been a small subarachnoid
isolation would be acceptable) haemorrhage but the bullet points
above can otherwise be satisfied, and
there is documented evidence of a full
clinical recovery, driving may resume
after 6 months.
Subdural haematoma
With any procedure, if another one is also undertaken (for example, a ventriculoperitoneal
shunt and a craniotomy for a haematoma), the standards for that procedure also apply,
and may take precedence.
Group 1 Group 2
Spontaneous acute subdural haematoma
Treated surgically Must not drive and must Must not drive and must
6 months off driving. At least 6 months off driving and will
require an individual assessment.
Spontaneous acute subdural haematoma
No surgical Must not drive and must Must not drive and must
treatment notify DVLA. notify DVLA.
Resume driving on recovery if no At least 6 months off driving and will
underlying lesion. require an individual assessment.
continued
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01
Chronic subdural haematoma or acute-on-chronic subdural haematoma
Treated with or Must not drive and must Must not drive and must
without surgery notify DVLA. notify DVLA.
Resume driving on recovery. 6 months is required if all of the
following apply:
■ the condition is uncomplicated
■ there is only 1 drainage procedure
■ there is no recurrence
■there are no multiple membranes
seen in the haematoma
All other cases require 1 year.
Traumatic subdural haematoma
At least 6 months off driving. Please see standards above for
traumatic brain injury.
Refusal or revocation:
May be able to return to driving when
risk of seizure has fallen to no greater
than 2% per annum.
Subarachnoid haemorrhage
Group 1 Group 2
Non-aneurysmal subarachnoid haemorrhage

This includes conditions that have different consequences for licensing including
perimesencephalic SAH: convexity SAH/cortical superficial siderosis causing transient focal
neurological events often attributed to CAA, and sometimes known as ‘amyloid spells’ and reversible
cerebral vasoconstriction syndrome.
Driving may resume on clinical Relicensing may be considered after
confirmation of recovery and, if no 6 months provided comprehensive
other cause has been identified, cerebrovascular imaging is normal,
documented normal cerebrovascular if no other cause has been identified,
imaging. and no debarring residual impairment
is likely to affect safe driving.
continued
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01
Group 1 Group 2
With intracranial aneurysm
Intervention not Must not drive and must Must not drive and must
currently needed notify DVLA. notify DVLA.
Relicensing may be considered after 6 The licence will be refused or revoked
months if there is no debarring residual permanently.
With intracranial aneurysm – non-middle cerebral artery
Treated by Must not drive but need not Must not drive and must
Driving may resume following clinical Relicensing may be considered
recovery. after 1 year if the patient scored
below 2 on the modified Rankin
Scale (MRS) at 2 months.
If the MRS score is 2 or higher
at 2 months, relicensing will not be
considered until after 2 years, and
will require no debarring residual
impairment likely to affect driving.
Treated Must not drive but need not Must not drive and must
endovascularly notify DVLA. notify DVLA.
recovery. after 6 months if the patient scored
below 2 on the modified Rankin
Scale (MRS) at 2 months.
at 2 months, relicensing will not be
considered until after 2 years, and
will require no debarring residual
impairment likely to affect driving.
With intracranial aneurysm – middle cerebral artery
recovery. after 2 years if the patient scored
below 2 on the modified Rankin Scale
(MRS) at 2 months.
at 2 months, the licence will be
refused or revoked. Relicensing
will not be considered until after
at least 2 years and a specialist
assessment. Annual seizure risk
should be no greater than 2% and
there should be no residual impairment
likely to affect driving.
continued
40 Contents
01
Group 1 Group 2
Treated Must not drive but need not Must not drive and must
Driving may resume following Relicensing may be considered
clinical recovery. after 2 years if the patient scored
below 2 on the modified Rankin Scale
(MRS) at 2 months.
at 2 months, the licence will be
refused or revoked. Relicensing
will not be considered until after
at least 2 years and a specialist
assessment. Annual seizure risk
should be no greater than 2% and
there should be no residual impairment
likely to affect driving.
Intracranial aneurysm
– truly incidental finding without haemorrhage
Group 1 Group 2
Treatment Providing there is no other relevant Must not drive and must
not currently condition, driving may continue and notify DVLA.
needed DVLA need not be notified. Relicensing may be considered if:
■ an aneurysm in the anterior
circulation (excluding cavernous
carotid) is less than 13 millimetres in
diameter
■ an aneurysm in the posterior
circulation is less than 7 millimetres
in diameter
Driving may resume following clinical Relicensing may be considered after
recovery. 1 year.
Treated Must not drive but need not Must not drive but need not
Driving may resume following clinical Driving may resume following clinical
recovery. recovery provided there are no
complications from the procedure.
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01
Arteriovenous malformation (AVM)
With any of the procedures, if another is also undertaken (for example, a ventriculoperitoneal
shunt or a craniotomy for a haematoma) the standards for that procedure also apply
and may take precedence.
Supratentorial
Group 1 Group 2
Intracerebral haemorrhage due to supratentorial AVM
Treatment not Must not drive but need not Must not drive and must
Driving may resume after 1 month The licence will be refused or revoked
provided there is no debarring residual permanently.
Relicensing may be considered after The licence will be refused or revoked.
6 months if there is no debarring Relicensing may be considered after
residual impairment likely to affect 10 years free of seizure since the last
safe driving. definitive treatment and the lesion
was completely removed or ablated.
There must be no debarring residual
embolisation notify DVLA. notify DVLA.
Driving may resume after 1 month The licence will be refused or revoked.
provided there is no debarring residual Relicensing may be considered after
impairment likely to affect safe driving. 10 years free of seizure since the last
definitive treatment and the lesion
stereotactic notify DVLA. notify DVLA.
radiotherapy
provided there is no debarring residual Relicensing may be considered after
impairment likely to affect safe 5 years free from seizure since the last
driving. definitive treatment and if the lesion
continued
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01
Incidental finding of supratentorial AVM (with no history of intracranial bleed)
Treatment not May drive and need not Must not drive and must
The licence will be refused or revoked
permanently.
Treated by surgery Must not drive and must Must not drive and must
or other mode notify DVLA. notify DVLA.
As for intracerebral haemorrhage due The licence will be refused or revoked.
to supratentorial AVM. As for intracerebral haemorrhage due
to supratentorial AVM.
Infratentorial AVM
Group 1 Group 2
Intracranial haemorrhage due to infratentorial AVM
Driving may resume after 1 month The licence will be refused or revoked
provided there is no debarring residual permanently.
Treated by May drive and need not Must not drive and must
provided there is no debarring residual Relicensing may be considered without
impairment likely to affect safe driving. the need for review on confirmation of
complete obliteration provided there is
no debarring residual impairment likely
Treated by May drive and need not Must not drive and must
embolisation or notify DVLA. notify DVLA.
stereotactic Driving may resume after 1 month The licence will be refused or revoked.
radiotherapy provided there is no debarring residual Relicensing may be considered without
impairment likely to affect safe driving. the need for review on confirmation of
continued
43 Contents
01
Incidental finding of infratentorial AVM
Relicensing may be considered on an
individual assessment.
Treated by surgery May drive and need not Must not drive and must
or other mode notify DVLA. notify DVLA.
There must be no debarring residual The licence will be refused or revoked.
impairment likely to affect safe driving. Relicensing may be considered without
the need for review on confirmation of
Dural arteriovenous fistula

Group 1 Group 2
Relicensing may be considered on an Relicensing may be considered on an
individual assessment. individual assessment.
Cavernous malformation
Cavernomas are also known as cavernous malformations, cavernous angiomas, or
cavernous haemangiomas. They are all surrounded by haemosiderin on brain MRI,
but this does not necessarily imply that they have ‘bled’ in the past. The risk of events
that might affect driving differs according to cavernoma location (brainstem versus
other locations) and symptoms attributable to the cavernoma (stroke versus epileptic
seizure versus no symptoms). A person’s age, the number of cavernomas, and the
size of the cavernoma do not seem to affect these risks.
With multiple cavernomas, licensing restrictions differ according to cavernoma
location, symptoms, or treatment. The most restrictive guidance will apply.
44 Contents
01
Supratentorial cavernoma
Group 1 Group 2
Incidental finding, May drive and need not May drive and need not
no surgical notify DVLA. notify DVLA.
treatment
With seizure, no Must not drive and must Must not drive and must
surgical treatment notify DVLA. notify DVLA.
The seizure rules (see Appendix B, The seizure rules (see Appendix B,
page 118) apply if there is a history page 118) apply if there is a history
of seizure. of seizure.
With haemorrhage May drive but must notify DVLA. Must not drive and must
and/or focal notify DVLA.
Driving will depend on the following:
neurological
there must be no debarring residual The licence will be refused or revoked
deficit, no surgical
■
impairment likely to affect safe driving. permanently.

treatment
The seizure rules (see Appendix B,
page 118) apply, and the patient must
not drive and must notify DVLA if there
is a history of seizure.
Driving may resume after 6 months The licence will be refused or revoked.
if there is no debarring residual Relicensing may be considered
impairment likely to affect safe driving. 10 years after surgical obliteration of
The seizure rules (see Appendix B, the lesion.
page 118) apply if there is a history The seizure rules (see Appendix B,
of seizure. page 118) apply.
Treated by May drive but must notify DVLA. Must not drive and must
radiosurgery, after notify DVLA.
haemorrhage and/
there must be no debarring residual The licence will be refused or revoked
or focal neurological
■
impairment likely to affect safe driving. permanently.

deficit
continued
45 Contents
01
Infratentorial cavernoma
Group 1 Group 2
Incidental finding May drive and need not May drive and need not
With haemorrhage May drive but must notify DVLA. Must not drive and must
and/or focal notify DVLA.
neurological
■ there must be no debarring residual The licence will be refused or revoked
deficit, no surgical permanently.
impairment likely to affect safe
treatment driving. The seizure rules (see Appendix B,
The seizure rules (see Appendix B, page 118) apply, and the patient must
page 118) apply, and the patient must not drive and must notify DVLA if there
not drive and must notify DVLA if there is a history of seizure.
Surgical treatment May drive but must notify DVLA. May drive but must notify DVLA.
by craniotomy
Driving will depend on the following: There must be no debarring residual
■ there must be no debarring residual impairment likely to affect safe driving.
impairment likely to affect safe driving The seizure rules (see Appendix B,
The seizure rules (see Appendix B, page 118) apply, and the patient must
page 118) apply, and the patient must not drive and must notify DVLA if there
not drive and must notify DVLA if there is a history of seizure.
Treated by May drive but must notify DVLA. Must not drive and must
radiosurgery notify DVLA.
(after haemorrhage and/ The licence will be refused or revoked
■ there must be no debarring residual
or focal neurological permanently.
deficit)
driving.
Intracerebral abscess/subdural empyema

Group 1 Group 2
Driving may resume after 1 year. The licence will be refused or revoked.
Given that there is a very high
prospective risk of seizure, it will be
10 years before relicensing may be
considered and there must have been
no seizures and no treatment for
seizures in that time.
46 Contents
01
Cranioplasty
Group 1 Group 2
May drive but must notify DVLA. Must not drive and must
Driving may resume on recovery. The notify DVLA.
underlying conditions that made the Driving may resume 6 months
surgical treatment necessary should following the surgical procedure.
be considered and the appropriate The underlying conditions that made
medical standard applied. the surgical treatment necessary
Individual consideration will be needed should be considered and the
in cases where subsequent revision appropriate medical standard applied.
surgery is required or the procedure Individual consideration will be needed
is complicated by post-operative in cases where subsequent revision
intracranial infection. surgery is required or the procedure
is complicated by post-operative
intracranial infection.
Chiari malformation
Group 1 Group 2
No treatment May drive and need not May drive and need not
required notify DVLA. notify DVLA.
Surgical treatment/foramen
magnum decompression
Group 1
car and motorcycle
Must not drive but need not Must not drive but need not
Driving may resume following clinical Driving may resume following clinical
confirmation that there are no residual confirmation that there are no residual
impairments likely to affect safe driving. impairments likely to affect safe driving.
47 Contents
01
Hydrocephalus
Group 1 Group 2
If the hydrocephalus is asymptomatic, Driving will be allowed to continue if
driving may continue under the ’til 70 the hydrocephalus is asymptomatic
licence. and there are no associated
neurological problems.
Intraventricular shunt or extraventricular drain

– insertion or revision of upper end of shunt or drain
Group 1 Group 2
May be relicensed after 6 months May be relicensed/licensed after a
if there is no debarring residual minimum of 6 months depending
impairment likely to affect safe driving. on individual assessment of the
underlying condition.
Neuroendoscopic procedures
– for example, third ventriculostomy
Group 1 Group 2
May be relicensed/licensed after 6 May be relicensed/licensed after a
months if there is no debarring residual minimum of 6 months depending
impairment likely to affect safe driving on individual assessment of the
and no other disqualifying condition. underlying condition.
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01
Intracranial pressure monitoring device
– inserted by burr hole surgery
Group 1 Group 2
May drive but need not Must not drive and must
The prospective risk from the The prospective risk from the
underlying condition must be underlying condition must be
considered. considered.
Implanted electrodes
Group 1 Group 2
Deep brain stimulation for movement disorder or pain
Must not drive until clinical Must not drive and must
confirmation of recovery. notify DVLA.
May drive if: Fitness to drive may be assessed for
■ there are no complications from relicensing if:
surgery ■ there are no complications from
■ the patient is seizure-free surgery

■ there is no debarring residual ■ the patient is seizure-free with
impairment likely to affect safe an underlying condition that is

driving non-progressive
■ there is no debarring residual
Need not notify DVLA.
driving
Implanted motor cortex stimulator for pain relief
May be relicensed/licensed after The licence will be refused or revoked.
6 months if the aetiology of the pain
is non-cerebral – trigeminal neuralgia,
for example.
If the aetiology is cerebral – stroke, for
example – may be relicensed/licensed
after 12 months provided there is no
debarring residual impairment likely to
affect safe driving.
49 Contents
02
02
Cardiovascular
disorders
Angina ....................................................................................................................................... 51
Acute coronary syndromes (ACS) (to include type 1 and
type 2 myocardial infarction; Takotsubo cardiomyopathy) .............................. 51
Elective percutaneous coronary intervention (PCI) ............................ 52
Coronary artery bypass graft (CABG) ................................................ 52
Coronary artery disease ................................................................... 52
Arrhythmias ............................................................................................................................ 53
Successful catheter ablation .......................................................................................... 53
Pacemaker implant ............................................................................................................. 54
Congenital complete heart block ................................................................................. 54
Implantable cardioverter defibrillator (ICD) ............................................................. 55
Aortic aneurysm ................................................................................................................... 58
Bicuspid aortopathy ............................................................................................................ 59
Aortic dissection ................................................................................................................... 60
Marfan syndrome and other inherited aortopathies ........................................... 61
Peripheral arterial disease .............................................................................................. 62
Hypertension .......................................................................................................................... 62
Cardiomyopathies ............................................................................................................... 62
Heart failure ............................................................................................................................ 64
Cardiac resynchronisation therapy (CRT) ................................................................. 65
Heart transplant .................................................................................................................... 66
Pulmonary arterial hypertension (including chronic
thromboembolic pulmonary hypertension) – an established
diagnosis (under the care of a specialist centre) ................................................. 66
Heart valve disease ............................................................................................................ 67
Aortic stenosis ....................................................................................................................... 67
Heart valve surgery ............................................................................................................ 68
Congenital heart disease (CHD) .................................................................................... 68
ECG abnormality ................................................................................................................... 69
Left bundle branch block ................................................................................................. 70
Pre-excitation ........................................................................................................................ 70
Long QT syndrome .............................................................................................................. 70
Brugada syndrome .......................................................................... 71
50 Contents
Chapter 02: Cardiovascular disorders
Angina
Group 1 Group 2
02
Angina Must not drive when symptoms Must notify DVLA. Must not drive
occur: when symptoms occur.
■ at rest A licence will be refused or revoked
■ with emotion if symptoms continue (treated or
untreated).
■ at the wheel
May be relicensed/licensed (provided
Driving may resume after satisfactory
there is no other disqualifying
symptom control.
condition) if:
Need not notify DVLA. ■ no angina for at least 6 weeks
■ the requirements for exercise or
other functional tests can be met

(see Appendix C, page 123)
Acute coronary syndromes (ACS) (to include type

1 and type 2 myocardial infarction; Takotsubo
cardiomyopathy)
Group 1 Group 2
Must not drive but need not Must not drive and must notify
notify DVLA. DVLA – for all ACS.
Driving may resume 1 week after Licence will be refused or revoked.
ACS if successful coronary intervention May be relicensed/licensed after at
(PCI) and if all of the following are met: least 6 weeks if:
■ no other urgent revascularisation
planned (urgent means within other functional tests can be met
4 weeks of acute event)
■ LV ejection fraction is at least 40%
before hospital discharge
■ there is no other disqualifying
condition
condition
No functional cardiac test is required
If not treated by successful coronary
in Takotsubo cardiomyopathy in the
intervention or any of the above are
absence of known coronary artery
not met, driving may resume only
disease.
after 4 weeks from the acute event,
provided there is no other disqualifying
condition.
Note: DVLA bars Group 2 bus and lorry licensing whenever left ventricular ejection fraction is less than 40%
51 Contents
Elective percutaneous coronary intervention (PCI)

Group 1 Group 2
02
Must not drive for at least 1 week Must not drive and must
but need not notify DVLA. notify DVLA.
Driving may resume after 1 week Licence will be refused or revoked.
provided there is no other disqualifying May be relicensed/licensed after at
condition. least 6 weeks if:
condition
Coronary artery bypass graft (CABG)

Group 1 Group 2
Must not drive for at leat 4 weeks Must not drive and must
but need not notify DVLA. notify DVLA.
Driving may resume after 4 weeks Licence will be refused or revoked.
provided there is no other disqualifying May be relicensed/licensed after
condition. 3 months if:
(see Appendix C, page 123), at least
3 months postoperatively
condition
Coronary artery disease

For Group 2 licensing, if there is evidence of obstructive coronary artery disease on
invasive or CT angiography or myocardial ischaemia on functional testing but it does
not fall under any of the categories above, those individuals would need to meet the
functional test requirements.
52 Contents
Arrhythmias
02
Arrhythmias include:
■ sinoatrial disease
■ significant atrioventricular conduction defect
■ atrial flutter/fibrillation
■ narrow or broad complex tachycardia
Note:
■ if a transient arrhythmia occurs during an acute coronary syndrome, the guidance
relating to ACS takes precedence (page 51)
■ pacemakers are considered separately (page 54)
Group 1 Group 2
Arrhythmia Must not drive if arrhythmia has Must notify DVLA. Must not drive
caused or is likely to cause incapacity. if arrhythmia has caused or is likely to
Driving may resume without DVLA cause incapacity.
notification only after: Licence will be refused or revoked.
■ underlying cause has been identified May be relicensed/licensed (provided
■ arrhythmia is controlled for at least there is no other disqualifying
4 weeks condition) only after:
■ underlying cause has been identified
Must notify the DVLA if there are
symptoms that are likely to cause ■ arrhythmia has been controlled for
incapacity and/or arrhythmia is not at least 3 months
controlled for at least 4 weeks, and ■ LV ejection fraction is at least 40%
an underlying cause has not been
identified. For the purposes of this guidance
‘incapacity’ is defined as any condition,
For the purposes of this guidance symptom or treatment that is likely to
‘incapacity’ is defined as any condition, cause an individual to be unable to
symptom or treatment that is likely to safely control or stop a vehicle.
cause an individual to be unable to
safely control or stop a vehicle.
Successful catheter ablation

Group 1 Group 2
For VT ablation with Must not drive for at least 4 weeks Must not drive and must
impaired ventricular but need not notify DVLA. notify DVLA.
function (right or left) Driving may resume after 4 weeks May be relicensed/licensed (provided
or congenital heart provided there is no other disqualifying there is no other disqualifying
disease (corrected or condition and arrhythmia has been condition) only after arrhythmia has
not) controlled. been controlled for at least 3 months
and LVEF at least 40%.
continued
53 Contents
Group 1 Group 2
02
For other ablations Must not drive for at least 2 days Must not drive for at least 2 weeks
but need not notify DVLA. but need not notify DVLA.
Driving may resume after 2 days Driving may resume after 2 weeks
provided there is no other disqualifying provided there is no other disqualifying
condition. condition and LVEF at least 40%.
Pacemaker implant
– including box change
Group 1 Group 2
Must not drive for at least 1 Must not drive for at least 6 weeks
week after pacemaker implant and and must notify DVLA.
pacemaker box change. Must notify DVLA of pacemaker
Must notify DVLA of pacemaker implantation. Need not notify DVLA of
implantation. Need not notify DVLA of pacemaker box change.
pacemaker box change. Driving may resume after 6 weeks
Driving may resume after 1 week provided there is no other disqualifying
provided there is no other disqualifying condition.
condition.
Congenital complete heart block

Group 1 Group 2
Asymptomatic May drive and need not Must not drive and must
Licence will be refused or revoked
permanently until pacemaker implanted.
Symptomatic Must not drive and must Must not drive and must
Licence will be refused or revoked until Licence will be refused or revoked
pacemaker implanted. permanently until pacemaker implanted.
54 Contents
Implantable cardioverter defibrillator (ICD)

02
In all cases of ICD implanted for sustained ventricular arrhythmia associated with incapacity,
driving must stop for 6 months from the date of ICD implantation and any resumption requires:
■ the device being under regular review with interrogation
■ no other disqualifying condition
■ all the requirements as below must be met

ICD implantation is a permanent bar to Group 2 licensing. In all cases of ICD implantation
(including prophylactic ICD implantation) driving must stop permanently and:
■ DVLA must be notified
■ the licence will be refused or revoked permanently
Group 1 Group 2
ICD implanted for sustained ventricular arrhythmia associated with incapacity
Without further Must not drive and must Must not drive and must
sequelae notify DVLA. notify DVLA.
Driving may resume after 6 months Licence will be refused or revoked
following implantation – except that permanently.
any of the sequelae 1-3 below require
further specific restrictions and may
require notification to DVLA.
1. With any shock If therapy delivery was due to an Must not drive and must
therapy, and/or inappropriate cause such as atrial notify DVLA.
anti-tachycardia fibrillation or programming issues Licence will be refused or revoked
pacing associated driving may resume 1 month after permanently.
with incapacity complete control of any cause to the
or likely to cause satisfaction of the cardiologist, and
incapacity (whether DVLA need not be notified.
incapacity caused by If therapy delivery was appropriate due
device or arrhythmia) to sustained ventricular tachycardia or
ventricular fibrillation, DVLA must be
notified and driving may resume
6 months after the event provided:
■ preventive steps against recurrence
have been taken with anti-arrhythmic
drugs, an ablation procedure, or ICD
programming alteration
and
continued
55 Contents
Group 1 Group 2
02
■ there is an absence of further
shock therapy and/or anti-
tachycardia pacing associated
with incapacity or likely to cause
incapacity
Otherwise, must not drive for 2 years
and must notify DVLA.
2. With any revision Must not drive for 1 month but Must not drive and must
of electrodes or need not notify DVLA. notify DVLA.
anti-arrhythmic drug
Driving may resume 1 month after Licence will be refused or revoked
treatment
electrode revision or drug alteration permanently.
provided there is no other disqualifying
condition.
3. With defibrillator Must not drive for 1 week but need Must not drive and must
box change not notify DVLA. notify DVLA.
Driving may resume 1 week after Licence will be refused or revoked
box change provided there is no other permanently.
disqualifying condition.
ICD implanted for sustained ventricular arrhythmia not associated with incapacity
Must not drive for 1 month Must not drive and must
following implantation and must notify DVLA.
notify DVLA. Licence will be refused or revoked
Driving may resume 1 month after permanently.
implantation provided all of the
following are met:
■ presentation was a ‘non-disqualifying’
cardiac event – i.e. haemodynamically

stable sustained ventricular
tachycardia without incapacity
■ LV ejection fraction is greater than 35%
■ any VT induced on electrophysiological

study has RR interval greater than
250 milliseconds
■ during the post implantation
electrophysiological study, any

induced VT could be pace-terminated
by the ICD twice, without acceleration
If any of the above not met, must not
drive for 6 months following implantation.
continued
56 Contents
Group 1 Group 2
02
Note: should ICD subsequently
deliver shock therapy and/or anti-
tachycardia pacing associated with or
likely to cause incapacity (except during
normal clinical testing), DVLA must
be notified and relevant restrictions
must be applied as detailed under the
heading ‘ICD implanted for sustained
ventricular arrhythmia associated with
incapacity’ (see page 55).
Prophylactic ICD
In asymptomatic Must not drive for 1 month following Must not drive and must
individuals implantation and must notify DVLA: notify DVLA.
with a high risk ■ driving may resume 1 month after Licence will be refused or revoked
of significant implantation if remains asymptomatic permanently.
arrhythmia and no ICD therapy needed For the purposes of this guidance
■ should the ICD subsequently ‘incapacity’ is defined as any
deliver shock therapy and/or condition, symptom or treatment
anti-tachycardia pacing associated that is likely to cause an individual to
with or likely to cause incapacity be unable to safely control or stop a
(except during normal clinical vehicle.
testing), DVLA must be notified and
relevant restrictions must be applied
as detailed under the heading ‘ICD
implanted for sustained ventricular
arrhythmia associated with
incapacity’ (see page 55)
For the purposes of this guidance
‘incapacity’ is defined as any
condition, symptom or treatment
that is likely to cause an individual to
be unable to safely control or stop a
vehicle.
57 Contents
Aortic aneurysm
– ascending or descending thoracic and/or abdominal
02
All patients must have regular medical review.
Note: for Group 2 cases, the exercise or other functional test requirements will need
to be met in all cases of abdominal aortic aneurysm.
Group 1 Group 2
Aortic aneurysm (see May drive and need not notify May drive if the aneurysm diameter
separate standards DVLA if aneurysm diameter is less is 5.5cm or less and there is no other
for people with than 6 cm and there is no other disqualifying condition.
bicuspid aortopathy disqualifying condition. Must notify DVLA*.
or Marfan’s
syndrome)
May drive but must notify DVLA if Must not drive and must notify
aneurysm diameter is between 6cm DVLA if the aneurysm diameter
and 6.4cm. is greater than 5.5cm.
May be relicensed/licensed subject Licence will be refused or revoked.
to annual review of licence and there is May be relicensed/licensed after
no other disqualifying condition. successful surgical or interventional
treatment if no aortic segment is greater
than 5.5cm in diameter and there is no
other disqualifying condition.*
Must not drive and must notify

DVLA if aneurysm diameter is 6.5cm
or greater.
Licence will be refused or revoked.
May be relicenced/licensed after
successful surgical or interventional
treatment if no aortic segment is
greater than 6.4 cm diameter and there
is no other disqualifying condition.
*The exercise or other functional test requirements will need to be met in all cases of abdominal aortic aneurysm.
58 Contents
Bicuspid aortopathy
02
Note: Assess risk factors for aortic dissection for all drivers with bicuspid aortopathy*
Group 1 Group 2
DVLA if the ascending aortic diameter DVLA if the ascending aortic diameter
is less than 5.5cm (or 5.0cm with a risk is less than 4.0 cm and there is no
factor for aortic dissection*) and there other disqualifying condition.
is no other disqualifying condition.
May drive but must notify DVLA if May drive but must notify DVLA if
ascending aortic diameter is 5.5-6.4cm the ascending aortic diameter is 4.0-
or greater (5.0-5.9 cm or greater with 5.5cm (4.0-5.0cm with a risk factor for
a risk factor for aortic dissection*) aortic dissection*) and there is no other
and there is no other disqualifying disqualifying condition
condition.
May be relicensed/licensed subject
May be relicensed subject to to annual review of licence and if there
annual review of licence and if there is is no other disqualifying condition
no other disqualifying condition
Must not drive and must notify Must not drive and must notify
DVLA if ascending aortic diameter is DVLA if ascending aortic diameter is
6.5cm or greater (6.0cm or greater with 5.5cm or greater (5.0cm or greater with
a risk factor for aortic dissection*). a risk factor for aortic dissection*).
Licence will be refused or revoked. Licence will be refused or revoked.
May be relicensed/licensed after
May be relicensed/licensed after successful surgical treatment without
successful surgical treatment without evidence of further enlargement
evidence of further enlargement and if there is no other disqualifying
and if there is no other disqualifying condition.
condition.
*Risk Factors for dissection include:

■ Coarctation of aorta
■ Systemic hypertension
■ Family history of dissection
■ Documented increase in aortic diameter greater than 3mm/year
59 Contents
Aortic dissection
02
Note: ‘satisfactory control of blood pressure’ means clinically relevant to aortic
dissection, not the DVLA standard for hypertension.
Group 1 Group 2
Type A Must not drive. Must notify DVLA. Must not drive and must
Licence will be refused or revoked. notify DVLA.
May be relicensed/licensed after Licence will be refused or revoked.
successful surgical treatment if: May be relicensed/licensed after
■ aortic diameter including the false successful surgical treatment if:
lumen is less than 6 cm ■ maximum transverse diameter of
■ satisfactory control of blood the aorta at any location is less than
pressure and treatment adherence 5.5cm (including the false lumen)
■ satisfactory medical follow-up ■ complete thrombosis of the false lumen
■ no other disqualifying condition ■ satisfactory control of blood
pressure and treatment adherence
■ satisfactory medical follow up
Type B Must not drive and must notify Must not drive and must notify
DVLA. DVLA.
Licence will be refused or revoked. Licence will be refused or revoked.
May be relicensed/licensed only after May be relicensed/licensed only after
successful surgical or interventional successful surgical or interventional
treatment, or with medical treatment if: treatment, or with medical treatment if:
■ aortic diameter (including the false ■ aortic diameter (including the false
lumen) at any location is 6.0cm lumen) at any location is 5.5cm

or less or less
■ satisfactory control of blood ■ complete thrombosis of the
pressure and treatment adherence false lumen

■ satisfactory medical follow-up ■ satisfactory control of blood
■ no other disqualifying condition pressure and treatment adherence

■ satisfactory medical follow up
60 Contents
Marfan syndrome and other

inherited aortopathies
02
Note: Assess risk factors for aortic dissection for all drivers with Marfan syndrome*
Group 1 Group 2
Marfan Syndrome May drive and need not notify Must notify DVLA.
without risk factors* DVLA if no aneurysm. Must not drive if:
■ maximum aortic diameter is greater
If there is an aortic aneurysm must than 5 cm

notify DVLA and must not drive if the ■ severe aortic regurgitation
aortic diameter exceeds 5cm. ■ any other disqualifying condition
Licence will be revoked/refused.
Marfan Syndrome May drive and need not notify Must notify DVLA.
with risk factors* DVLA if no aneurysm. Must not drive if:
If there is an aortic aneurysm must ■ maximum aortic diameter is greater
notify DVLA and must not drive if the than 4.5 cm

aortic diameter exceeds 4.5cm. ■ severe aortic regurgitation
■ any other disqualifying condition
Licence will be revoked/refused.
Marfan Syndrome Driving may resume after successful

Debarred if emergency aortic
and aortic surgery surgical treatment (whether emergency
surgery.
or elective repair) and there is no other
disqualifying condition. Elective aortic surgery – individual
assessment (see Appendix C for
full details).
Other inherited Must not drive and must notify Must not drive and must notify
aortopathies DVLA. DVLA.
(for example, Loeys- Licence will be refused or revoked. Licence will be refused or revoked.
Dietz syndrome, Driving may resume after individual
vascular type IV specialist assessment.
Ehlers-Danlos
syndrome)
*Risk Factors include:

■ Family history of aortic dissection
■ Severe aortic or mitral regurgitation
■ Greater than 3mm per year increase than aneurysm diameter
■ Pregnancy
61 Contents
Peripheral arterial disease

Group 1 Group 2
02
May drive and need not May drive but must notify DVLA.
notify DVLA. May be relicenced/licensed only if:
There must be no other disqualifying ■ there is no symptomatic myocardial
condition. ischemia, and
■ the exercise or other functional
test requirements can be met
Hypertension
Group 1 Group 2
DVLA, except: DVLA, except:
Must not drive if diagnosed with Must not drive and must notify
malignant hypertension until condition DVLA if resting BP is consistently:
has been effectively treated or ■ 180mm Hg or higher systolic and/or
controlled but need not notify DVLA.
■ 100mm Hg or more diastolic
(Malignant hypertension: elevation in
systolic blood pressure greater than ■ or if diagnosed with malignant
or equal to 180 mm Hg or diastolic hypertension
blood pressure greater than 110 May be relicensed/licensed after BP is
mm Hg associated with evidence of controlled, provided there are no
progressive organ damage). side-effects from treatment that affect
or are likely to affect safe driving.
Cardiomyopathies
Note: DVLA bars Group 2 bus and lorry licensing whenever left ventricular ejection fraction
is less than 40%.
Also refer to the following sections in this document:

■ arrhythmias (page 53)
■ pacemaker implant (page 54)
■ implantable cardioverter defibrillator (page 55).
■ European Society of Cardiology HCM Risk of Sudden Cardiac Death Calculator

in Appendix C (page 124)
continued
62 Contents
Group 1 Group 2
02
Hypertrophic cardiomyopathy (HCM)
Asymptomatic May drive and need not Must not drive and must notify DVLA.
notify DVLA. Must not drive if in the High Risk group
There must be no other disqualifying (as per ESC HCM Risk-SCD calculator –
condition. see Appendix C for details) and/or if ICD
is indicated/implanted. If in the Low Risk
or Intermediate Risk group licensing
will be permitted if the applicant is
able to complete the full 9 minutes
of the standard exercise tolerance
test (or energy equivalent using a
cycle ergometer) (see Appendix C for
details). Should the applicant be unable
to exercise for non-cardiovascular
reasons cardiac MRI imaging must not
reveal more than 15% of ventricular
myocardium demonstrating gadolinium
enhancement.
Symptomatic May drive and need not Must not drive and must
There must be no other disqualifying Licence will be refused or revoked.
condition (must meet all other relevant Relicensing will be considered once
standards e.g. angina, arrhythmia). symptoms are satisfactorily controlled
and the criteria for asymptomatic HCM
met as detailed above. If there is a history
of associated syncope the standards
for syncope need to be met in addition.
Dilated cardiomyopathy
Asymptomatic May drive and need not May drive but must notify DVLA.
notify DVLA. LV ejection fraction must be at least
There must be no other disqualifying 40% and there must be no other
condition. disqualifying condition.
There must be no other disqualifying Licence may be issued/renewed once
condition (must meet all other asymptomatic, if LV ejection fraction
standards e.g. angina arrhythmia). is at least 40% and there is no other
disqualifying condition.
Arrhythmogenic right ventricular cardiomyopathy

and allied disorders
Asymptomatic May drive and need not Must not drive and must
May be relicensed/licensed following
specialist electrophysiological
assessment, provided there is no
other disqualifying condition.
continued
63 Contents
Symptomatic Must not drive and must notify Must not drive and must
DVLA if arrhythmia has caused notify DVLA.
or is likely to cause incapacity (see Licence will be refused or revoked.
02
page 53).
Relicensing may be permitted if:
May be relicensed/licensed once
■ the applicant is on treatment
arrhythmia is controlled, provided there
is no other disqualifying condition. ■ the applicant has remained
asymptomatic for a period of

1 year and
■ the applicant remains under regular
specialist electrophysiological review

A 1–3 year licence may be considered
if the specialist electrophysiological
review is satisfactory.
For the purposes of this guidance
‘incapacity’ is defined as any condition,
symptom or treatment that is likely to
cause an individual to be unable to
safely control or stop a vehicle.
Heart failure
Please refer to NYHA classification detailed on page 63.
Group 1 Group 2
Asymptomatic May drive and need not May drive if LV ejection fraction is
NYHA class I notify DVLA. at least 40% but must notify DVLA.
Symptomatic May drive if symptoms are stable May drive if left ventricular ejection
NYHA class II and not likely to distract the driver or fraction is at least 40%, symptoms
otherwise affect safe driving but need are stable and not likely to distract the
not notify DVLA. driver or otherwise affect safe driving
but must notify DVLA.
NYHA class III May drive if symptoms are stable Must not drive and must
and not likely to distract the driver or notify DVLA.
otherwise affect safe driving but need License will be refused/revoked.
not notify DVLA.
Relicensing can only be considered if
symptoms controlled and in NYHA I or
II, and left ventricular ejection fraction
is at least 40%.
NYHA class IV Must not drive and must Must not drive and must
License will be refused/revoked. License will be refused/revoked.
Relicensing can only be considered if Relicensing can only be considered if
symptoms controlled and in NYHA I, symptoms controlled and in NYHA I or
II or III. II, and left ventricular ejection fraction
is at least 40%.
Depending on the likely cause for heart
failure, exercise or other functional
testing may be required irrespective of
the NYHA class (see Appendix C).
continued
64 Contents
Left ventricular Must not drive and must Must not drive and must
assist device notify DVLA. notify DVLA.
implanted Driving may be relicensed under Licence will be refused or revoked
02
individual assessment only after permanently.
3 months from implantation.
New York Heart Association (NYHA) Classification of heart failure

The New York Heart Association (NYHA) classification is used to grade the severity
of functional limitations in a patient with heart failure (1):
■ class I no limitation of physical activity
■ ordinary physical activity does not cause fatigue, breathlessness or palpitation
(includes asymptomatic left ventricular dysfunction)

■ class II slight limitation of physical activity
■ patients are comfortable at rest. Ordinary physical activity results in fatigue,
palpitation, breathlessness or angina pectoris (symptomatically ‘mild’ heart failure)

■ class III marked limitation of physical activity
■ although patients are comfortable at rest, less than ordinary activity will lead
to symptoms (symptomatically ‘moderate’ heart failure)

■ class IV inability to carry out any physical activity without discomfort
■ symptoms of congestive cardiac failure are present even at rest. Increased
discomfort with any physical activity (symptomatically ‘severe’ heart failure)
Cardiac resynchronisation therapy (CRT)

Group 1 Group 2
CRT pacemaker Must not drive for 1 week and Must not drive and must
must notify DVLA. notify DVLA.
Driving may resume after at least Driving may resume after at least
1 week following implantation if: 6 weeks following implantation if:
■ there are no symptoms likely to ■ LV ejection fraction is at least 40%
affect safe driving ■ the requirements under heart failure

■ there is no other disqualifying section (see above) are met
condition ■ there is no other disqualifying
condition
CRT defibrillator May drive subject to following Must not drive and must
provisions being met but must notify notify DVLA.
DVLA. Licence will be refused or revoked
Provisions: permanently.
■ the requirements under implantable
cardioverter defribillator (ICD) are met

■ there is no other disqualifying condition
65 Contents
Heart transplant
– including heart and lung transplant
02
Group 1 Group 2
Must not drive for at least 6 weeks Must not drive for at least 3
after surgery. Need not notify DVLA. months following surgery and must
There must be no other disqualifying notify DVLA.
condition. May be relicensed after 3 months
provided:
■ remains asymptomatic
■ any exercise or other functional
testing requirements from DVLA
are met
■ LV ejection fraction at least 40%
condition
Pulmonary arterial hypertension (including chronic

thromboembolic pulmonary hypertension)
– an established diagnosis (under the care of a specialist centre)
Group 1 Group 2
Must notify DVLA. Must not drive and must

Low, intermediate risk category notify DVLA.
May drive provided no other Low risk category
disqualifying condition. Review 3 year Driving may be allowed provided
licence to be issued. satisfactory specialist assessment
High risk category and the risk of a sudden and disabling
event is deemed to be less than 2%
May drive provided satisfactory
per annum; there should be no other
specialist assessment and the risk of a
disqualifying condition and syncope
sudden and disabling event is deemed
standards need to be met.
to be less than 20% per annum;
there should be no other disqualifying Review 1 year licence will be issued.
condition and syncope standards need Intermediate, high risk category
to be met. Licence will be refused or revoked.
Review 1 year licence to be issued. Classification of low, intermediate or
Classification of low, intermediate or high risk categories as per 2015 ESC/
high risk categories as per 2015 ESC/ ERS Guidelines for the diagnosis and
ERS guidelines for the diagnosis and treatment of pulmonary hypertension.
treatment of pulmonary hypertension. Specialist assessment report will be
Specialist assessment report will be needed for the above risk assessment.
needed for the above risk assessment.
66 Contents
Heart valve disease

Note:
02
■ also refer to heart valve surgery (see page 66)
■ separate standards for aortic stenosis, see below
Group 1 Group 2
Heart valve disease
Asymptomatic May drive and need not May drive and need not
There must be no other disqualifying There must be no other disqualifying
condition. condition.
(please refer to heart notify DVLA. notify DVLA.
failure standards if
There must be no other disqualifying Relicensing considered once
relevant)
condition. asymptomatic and no other disqualifying
conditions.
If there is cerebral embolism, relicensing
may be considered after 12 months
following cardiological assessment.
Aortic stenosis
(to include sub-aortic and supra-aortic stenosis, RVOT obstruction)
See Appendix C for the definition of ‘severe’ asymptomatic aortic stenosis (page 123).
Group 1 Group 2
Asymptomatic May drive and need not If mild to moderate aortic stenosis,
notify DVLA. may drive and need not notify DVLA.
Moderate aortic stenosis must be under
regular medical review and DVLA must
be notified if this progresses to severe
aortic stenosis.
If severe aortic stenosis, must not
drive and must notify DVLA.
An annual review licence may be
issued, provided:
■ DVLA exercise tolerance test
requirements are met (see Appendix

C, page 123)
■ there is satisfactory medical follow-up
continued
67 Contents
Licensing will be refused if:

■ during an exercise test symptoms
develop, blood pressure falls or there

is sustained arrhythmia
02
■ a cardiologist considers that
exercise testing would be unsafe for

the individual
■ a test is not possible for any other
reason
Symptomatic Must not drive and must notify Must not drive and must
DVLA. notify DVLA.
Licence will be refused or revoked Licence will be refused or revoked
pending assessment and treatment. pending assessment and treatment.
Heart valve surgery

– including transcatheter aortic valve implantation and other
cardiac or pulmonary percutaneous devices
Group 1 Group 2
Must not drive for 4 weeks but Must not drive for 3 months and
need not notify DVLA. must notify DVLA.
Driving may resume only after 4 weeks, May be relicensed/licensed only after
provided there is no other disqualifying 3 months, provided:
condition. ■ no evidence of significant left
ventricular impairment – that is,

LV ejection fraction at least 40%
■ no ongoing symptoms
Congenital heart disease (CHD)

Group 1 Group 2
Asymptomatic May drive and need not notify May drive but must notify DVLA.
DVLA if asymptomatic and does not Licence will be refused or revoked if
fall under any other category which CHD is severe*.
requires notification to DVLA. Otherwise, DVLA may issue a licence
subject to medical review at 1, 2
or 3 years, depending on specialist
assessment and provided there is:
■ mild/moderate disease*
■ successful cardiac or pulmonary
intervention (percutaneous device

or surgery)
continued
68 Contents
Symptomatic Must not drive and must Must not drive and must notify
notify DVLA. DVLA. Licence will be refused or
revoked if CHD is severe*.
02
Symptoms include angina,
palpitations, dyspnoea, symptoms Otherwise, following individual
related to uncontrolled hypertension, assessment of cases, DVLA may
heart failure, heart valve disease. issue a licence subject to medical
For patients with congenital heart review at 1, 2 or 3 years, depending
disease who have had ablation, on specialist assessment and provided
pacemaker including CRT, ICD, there is:
heart valve intervention (surgical ■ mild/moderate disease*
or percutaneous) or percutaneous ■ successful cardiac or pulmonary

cardiac/pulmonary devices (ASD/ intervention (percutaneous device
VSD/coarctation/MAPCAs/pulmonary- or surgery)
systemic shunts etc) – if symptoms
develop after being asymptomatic or
if they fall under any other category
which requires notification to DVLA,
must notify DVLA.
Individual assessment of symptomatic
cases. DVLA may require specialist
assessment to issue a licence, which
may be subject to medical review at
1, 2, or 3 years.
There must be no other disqualifying
condition.
*See classification of congenital heart disease complexity and the section in Appendix C.
For syncope, refer to Chapter 1
■ Transient loss of consciousness (page 21)
ECG abnormality
– suspected myocardial infarction
Group 1 Group 2
There must be no other disqualifying May be relicensed/licensed, provided:
condition. ■ exercise or other functional test
requirements from DVLA are met
condition
69 Contents
Left bundle branch block

Group 1 Group 2
02
May drive and need not May drive but must notify DVLA.
notify DVLA. May be relicensed/licensed if:
There must be no other disqualifying ■ myocardial perfusion scan or stress
condition. echocardiography requirements from
DVLA are met (see Appendix C,
page 123)
condition
Pre-excitation
Group 1 Group 2
May drive and need not May drive and need not notify
notify DVLA. DVLA, except:
There must be no other disqualifying If associated with arrhythmia must
condition. meet the relevant requirements (see
arrhythmias on page 53).
There must be no other disqualifying
condition.
Long QT syndrome
– all cases of Long QT syndrome must notify DVLA
Group 1 Group 2
Must not drive if history of syncope Must not drive if symptomatic or

or Torsades de pointes or QTc* greater history of syncope or Torsades de
than 500ms and must notify DVLA. pointes or QTc* greater than 500ms
Licence will be refused/revoked. and must notify DVLA.
Relicensing will be considered upon Licence will be refused/revoked.
appropriate specialist cardiologist Relicensing may be considered once
assessment and standards of asymptomatic and upon appropriate
syncope met. specialist cardiologist assessment and
*corrected QT interval standards of syncope met.
*corrected QT interval
70 Contents
Brugada syndrome
– all cases of Brugada syndrome must notify DVLA
02
Group 1 Group 2
Must not drive if history of syncope Must not drive if symptomatic or

possibly associated to Brugada history of syncope possibly associated
syndrome or history of sudden aborted to Brugada syndrome or history of
cardiac death and must notify DVLA. sudden aborted cardiac death and
Licence will be refused/revoked. must notify DVLA.
Relicensing will be considered upon Licence will be refused/revoked
appropriate specialist cardiologist permanently if history of syncope
assessment. possibly associated to Brugada
syndrome or history of sudden
aborted cardiac death.
Otherwise, relicensing may be
considered once asymptomatic
and upon appropriate specialist
cardiologist assessment and standards
of syncope met.
71 Contents
03 Diabetes
03
mellitus
Diabetes mellitus .................................................................................................................. 73
Insulin-treated diabetes .................................................................................................... 73
Impaired awareness of hypoglycaemia ..................................................................... 76
Diabetes complications ..................................................................................................... 76
Visual complications ........................................................................................................... 76
Renal complications ........................................................................................................... 77
Limb complications ............................................................................................................. 77
Temporary insulin treatment ........................................................................................... 77
Diabetes treated by medication other then insulin .............................................. 78
Diabetes managed by diet/lifestyle alone ................................................................ 79
Severe hypoglycaemia due to causes other than diabetes management .... 79
Pancreas transplant ............................................................................................................. 80
Islet cell transplantation .................................................................................................... 80
Seizures provoked by hypoglycaemia ........................................................................ 80
72 Contents
Chapter 03: Diabetes mellitus
Diabetes mellitus
Information sent to drivers
Insulin-treated drivers are sent a detailed letter from DVLA explaining the licensing
requirements and driving responsibilities. (see INF294 Appendix D, page 127).
03
All drivers with diabetes must follow the information provided in ‘Information for
drivers with diabetes’, which includes a notice of when they must contact DVLA
(see Appendix D, page 127).
Insulin-treated diabetes
Adequate awareness of hypoglycaemia
The Secretary of State’s Honorary Medical Advisory Panel on Driving and Diabetes
has defined adequate awareness of hypoglycaemia as whether ‘the licence holder/
applicant [is] capable of bringing their vehicle to a safe controlled stop’.
This is a matter of professional judgement and as a guide the duration of
hypoglycaemic symptoms experienced should be compatible with bringing a vehicle to
a safe controlled stop.
The reliance on alarms on glucose monitoring devices are not accepted as a substitute
for adequate symptomatic or physiological awareness of hypoglycaemia experienced
by the driver.
Should a driver become reliant on these alarms to advise them that they are
hypoglycaemic they must stop driving and notify DVLA.
Impaired awareness of hypoglycaemia
The Panel has also defined impaired awareness of hypoglycaemia for Group 1 drivers
as ‘an inability to detect the onset of hypoglycaemia because of total absence of
warning symptoms’.
Group 2 drivers must have full awareness of hypoglycaemia.
Severe hypoglycaemia
The law defines ‘severe’ as an episode of hypoglycaemia requiring the assistance of
another person.
Group 1 drivers – episodes of hypoglycaemia occurring during established sleep
are no longer considered relevant for licensing purposes unless there are concerns
regarding their hypoglycaemia awareness.
Group 2 drivers – must report all episodes of severe hypoglycaemia requiring the
assistance of another person.
Interstitial glucose monitoring systems
These devices are more widely known as flash glucose monitoring systems (Flash GM)
and real-time continuous glucose monitoring systems (RT-CGM).
continued
73 Contents
Group 1
These systems may be used for monitoring glucose at times relevant to driving Group
1 vehicles. Users of these systems must carry finger prick capillary glucose testing
equipment for driving purposes as there are times when a confirmatory finger prick
blood glucose level is required.
If using an interstitial fluid continuous glucose monitoring system (Flash GM or
03
RT-CGM), the blood glucose level must be confirmed with a finger prick blood
glucose reading in the following circumstances:
■ when the glucose level is 4.0 mmol/L or below
■ when symptoms of hypoglycaemia are being experienced
■ when the glucose monitoring system gives a reading that is not consistent with the
symptoms being experienced (for example symptoms of hypoglycaemia and the system
reading does not indicate this) – see INF294 Appendix D, page 127 for further details
Group 2
There is a legal requirement for Group 2 drivers to monitor their blood glucose for the
purpose of Group 2 driving.
Flash GM and RT-CGM interstitial fluid glucose monitoring systems are not permitted
for the purposes of Group 2 driving and licensing.
Group 2 drivers who use these devices must continue to monitor finger prick capillary
blood glucose levels with the regularity defined below.
Group 1 Group 2
Must meet the criteria to drive and Must meet the criteria to drive and
must notify DVLA. must notify DVLA.
All the following criteria must be All the following criteria must be met
met for DVLA to license the person for DVLA to license the person with
withinsulin-treated diabetes for 1, 2 insulin-treated diabetes for 1 year (with
or 3 years: annual review as indicated last below):
■ adequate awareness of ■ full awareness of hypoglycaemia
hypoglycaemia ■ no episode of severe hypoglycaemia
■ no more than 1 episode of severe in the preceding 12 months
hypoglycaemia while awake in the ■ practises blood glucose monitoring
preceding 12 months and the most with the regularity defined in the
recent episode occurred more than box below.
3 months ago (see recurrent severe
■ must use a blood glucose meter with
hypoglycaemia guidance below).
sufficient memory to store 3 months
■ practises appropriate glucose of readings as detailed below
monitoring as defined in the box
■ demonstrates an understanding of
below
the risks of hypoglycaemia
■ not regarded as a likely risk to the
■ no disqualifying complications of
public while driving
diabetes (see page 77) that would
■ meets the visual standards for acuity mean a licence being refused or
and visual field (see Chapter 6, revoked, such as visual field defect
visual disorders, page 98) (see Chapter 6, visual disorders,
■ under regular review page 98)
74 Contents
Group 1 and Group 2 requirements for insulin-treated drivers licensed on review

The Secretary of State’s Honorary Medical Advisory Panel on Driving and Diabetes
has defined the glucose self-monitoring requirements for licensing as follows.
■
glucose testing no more than 2 hours before the start of the first journey
03
and
■ every 2 hours after driving has started
■ a maximum of 2 hours should pass between the pre-driving glucose test and the
first glucose check performed after driving has started
■ applicants will be asked to sign an undertaking to comply with the directions of
the healthcare professionals treating their diabetes and to report any significant
change in their condition to DVLA immediately
More frequent self-monitoring may be required with any greater risk of hypoglycaemia
(physical activity, altered meal routine).
■
regular blood glucose testing – at least twice daily including on days when not driving
and
■ no more than 2 hours before the start of the first journey
and
■ every 2 hours after driving has started
■ a maximum of 2 hours should pass between the pre-driving glucose test and the
first glucose check performed after driving has started
More frequent self-monitoring may be required with any greater risk of hypoglycaemia
(physical activity, altered meal routine), in which case a bus or lorry driver may be
licensed if they:
■ use one or more blood glucose meters with memory functions to ensure 3 months
of readings whilst on insulin that will be available for assessment
How DVLA checks diabetes management requirements for

insulin-treated Group 2 bus and lorry licensing
DVLA takes the following measures to ensure the requirements are met for licensing
of insulin-treated Group 2 bus and lorry drivers:
■ applicants must stop driving Group 2 vehicles when they commence insulin until
DVLA has made a licensing decision
■ requires the applicant’s usual doctor who provides diabetes care to undertake an
examination at least every 3 years including review of the previous 3 months of
blood glucose meter readings
■ arranges an examination to be undertaken every 12 months by an independent
consultant specialist in diabetes if the examination by their usual doctor is satisfactory
■ at the examination, the consultant will require sight of blood glucose self-monitoring
records for the previous 3 months stored on the memory of a blood glucose meter
■ the license application process cannot start until an applicant’s condition has
been stable for at least 1 month, and they can provide 2 months of blood glucose
readings taken whilst on insulin
continued
75 Contents
■ applicants will be asked to sign an undertaking to comply with the directions of

the healthcare professionals treating their diabetes and to report any significant
change in their condition to DVLA immediately
Recurrent severe hypoglycaemia guidance

Advice for Group 1 drivers who have had more than one episode of severe
03
hypoglycaemia while awake in the last 12 months
must
not drive and must notify DVLA.
DVLA will then carry out medical enquiries before a licensing decision is made.
Advice for Group 2 drivers after every episode of severe hypoglycaemia in the
last 12 months
must not drive and must notify DVLA following all episodes of severe hypoglycaemia.
Severe hypoglycaemia whilst driving

All Group 1 and Group 2 drivers who experience an episode of severe hypoglycaemia
whilst driving must not drive and must notify DVLA.
Impaired awareness of hypoglycaemia

– ‘hypoglycaemia unawareness’
Group 1 Group 2
Driving may resume after a clinical The licence will be refused or revoked.
report by a GP or consultant diabetes Refer to the requirements for insulin-
specialist confirms that adequate treated diabetes on page 73.
hypoglycaemia awareness has been
regained.
Diabetes complications
Visual complications
– affecting visual acuity or visual field
Group 1 Group 2
May need to stop driving and Must not drive and must
Refer to Chapter 6, visual disorders The licence will be refused or revoked.
(page 98). Refer to insulin-treated diabetes
(page 73) and Chapter 6, visual
disorders (page 98).
76 Contents
Renal complications
Group 1 Group 2
May need to stop driving and May need to stop driving and
03
Refer to Chapter 7, renal and Refer to Chapter 7, renal and
respiratory disorders (page 106). respiratory disorders (page 106).
Limb complications
– including peripheral neuropathy
Group 1 Group 2
Any complication May need to stop driving and May need to stop driving and
such as peripheral notify DVLA. notify DVLA.
neuropathy that
See Appendix F, disabilities and See Appendix F, disabilities and
means a driver must vehicle adaptations (page 130). vehicle adaptations (page 130).
meet requirements
Limb problems or amputations are of Limb problems or amputations are of
(such as vehicle themselves unlikely to prevent driving themselves unlikely to prevent driving
adaptations) for since they may be assisted by suitable since they may be assisted by suitable
disabilities vehicle adaptations. The ability to vehicle adaptations. The ability to
safely control a vehicle at all times is safely control a vehicle at all times is
the essential requirement. the essential requirement.
Temporary insulin treatment

– including gestational diabetes or post-myocardial infarction
Group 1 Group 2
Trial participants May drive and need not notify Must notify DVLA and meet the
for oral or inhaled DVLA, provided: above standards.
insulin are also ■ under medical supervision
examples to be
■ not advised by clinician as at risk
included as receiving
of disabling hypoglycaemia
temporary insulin
treatment May continue to drive but must
notify DVLA if:
■ disabling hypoglycaemia occurs
■ treatment continues for more than
3 months – or in gestational diabetes,
continues for 3 months after delivery
77 Contents
Diabetes treated by medication other than insulin

The law defines ‘severe’ as an episode of hypoglycaemia requiring the assistance
of another person.
03
All Group 1 and Group 2 drivers who experience an episode of severe hypoglycaemia
whilst driving must not drive and must notify DVLA.
Group 1 Group 2
Managed by tablets carrying hypoglycaemia risk
Including May drive and need not notify May drive but must notify DVLA.
sulphonylureas and DVLA, provided: All the following criteria must be met
glinides (for example ■ no more than 1 episode of severe for DVLA to issue a licence for 1, 2 or
Repaglinide, hypoglycaemia while awake in the last 3 years:
Nateglinide) 12 months and the most recent episode ■ no episode of severe hypoglycaemia
occurred more than 3 months ago in the last 12 months
■ should practise appropriate ■ full awareness of hypoglycaemia
glucose monitoring at times
■ regular self-monitoring of blood
relevant to driving
glucose – at least twice daily and
■ under regular review at times relevant to driving i.e. no
It is appropriate to offer self more than 2 hours before the start
monitoring of blood glucose at times of the first journey and every 2 hours
relevant to driving to enable the while driving
detection of hypoglycaemia. ■ demonstrates an understanding of
If the above requirements and those the risks of hypoglycaemia
set out in Appendix D (page 127) are ■ has no disqualifying complications of
met, DVLA need not be informed. diabetes that mean a licence will be
DVLA must be notified if clinical refused or revoked, such as visual
information indicates the agency may field defect
need to undertake medical enquiries.
Managed by other medication. Such medication includes Metformin, DPP-4 inhibitors

(gliptins), SGLT2 inhibitors, GLP-1 agonists and non-insulin injectables.
May drive and need not notify May drive but must notify DVLA.
DVLA, provided the requirements set DVLA may issue a licence if the
out in Appendix D (page 127) are met requirements set out in Appendix D
and the driver is under regular medical (page 127) are met and the driver is
review. under regular medical review.
May drive but must notify DVLA A licence is refused or revoked if
if clinical information indicates the relevant disqualifying complications
agency may need to undertake have developed, such as diabetic
medical enquiries. retinopathy affecting visual acuity or
visual fields.
A short-term licence may be issued
if diabetes complications have
developed but the required medical
standards have been met.
78 Contents
Diabetes managed by diet/lifestyle alone

Group 1 Group 2
May drive and need not notify DVLA. May drive and need not notify DVLA.
03
Must not drive and must notify Must not drive and must notify
DVLA if, for example: DVLA if, for example:
■ relevant disqualifying complications ■ relevant disqualifying complications
develop such as diabetic retinopathy develop such as diabetic retinopathy
affecting visual acuity or visual fields affecting visual acuity or visual fields
■ insulin treatment is required (see ■ insulin treatment is required (see
the requirements for insulin-treated the requirements for insulin-treated
diabetes on page 73) diabetes on page 73)
Severe hypoglycaemia due to causes

other than diabetes management
Examples include hypoglycaemia post-bariatric surgery or in association with eating
disorders, and the restriction applies for both car and motorcycle, and bus and lorry drivers.
The law defines ‘severe’ as an episode of hypoglycaemia requiring the assistance of
another person.
If there are episodes of severe hypoglycaemia from any cause other than diabetes
treatment driving must stop and the driver must notify DVLA.
Group 1 Group 2
The following criteria must be met The following criteria must be met for
for DVLA to license the person DVLA to license the person experiencing
experiencing severe hypoglycaemia severe hypoglycaemia due to causes
due to causes other than diabetes other than diabetes management:
management: ■ full awareness of hypoglycaemia
■ adequate awareness of
■ no episode of severe hypoglycaemia
hypoglycaemia in the preceding 12 months
■ practices appropriate glucose
■ practices appropriate glucose
monitoring as defined in the text monitoring with the regularity defined
below in the text below
the risks of hypoglycaemia the risks of hypoglycaemia
public when driving public when driving
■ remains under regular clinical
■ remains under regular clinical
review for the management of the review for the management of the
underlying medical condition underlying medical condition
■ glucose testing no more than 2 hours ■ regular blood glucose testing – at

before the start of the first journey least twice daily including on days
and when not driving
and
continued
79 Contents
■ every 2 hours after driving has started ■ no more than 2 hours before the
■ a maximum of 2 hours should pass start of the first journey and
between the pre-driving glucose ■ every 2 hours after driving has started
test and the first glucose check ■ a maximum of 2 hours should pass
performed after driving has started between the pre-driving glucose
More frequent self-monitoring may test and the first glucose check
be required with any greater risk of performed after driving has started
03
hypoglycaemia (physical activity, More frequent self-monitoring may
altered meal routine). be required with any greater risk of
hypoglycaemia (physical activity,
altered meal routine).
Pancreas transplant
Group 1 Group 2
May drive but must notify DVLA. May drive but must notify DVLA.
Licensing is on the provision that the Licensing will require individual
patient has no disqualifying condition. assessment.
If the patient is on insulin, refer to page 73 If the patient is on insulin, refer to page 73
for the section on insulin-treated diabetes. for the section on insulin-treated diabetes.
Islet cell transplantation

Group 1 Group 2
May drive but must notify DVLA. May drive but must notify DVLA.
Licensing is on the provision that the Licensing will require individual
patient has no disqualifying condition, assessment.
and is issued for a term requiring If the patient is on insulin, refer to
medical review. page 73 for the section on insulin-
If the patient is on insulin, refer to treated diabetes.
page 73 for the section on insulin-
treated diabetes.
Seizures provoked by hypoglycaemia

Seizures provoked by hypoglycaemia now require a period off driving due to the prospective
risk of a further seizure.
Group 1 Group 2
Must not drive and must notify DVLA. Must stop driving and must notify DVLA.
See ‘Provoked seizures’ under See ‘Provoked seizures’ under
Epilepsy and seizures, page 18. Epilepsy and seizures, page 18.
80 Contents
04 Psychiatric
disorders
04
Anxiety or depression ......................................................................................................... 82
Severe anxiety or depression ......................................................................................... 82
Psychotic disorder – including acute episode ........................................................ 83
Hypomania or mania ........................................................................................................... 84
Schizophrenia ......................................................................................................................... 85
Neurological developmental conditions ..................................................................... 86
Cognitive impairment (not mild dementia) ............................................................... 87
Dementia .................................................................................................................................. 87
Learning disability ................................................................................................................ 88
Behavioural disorders ......................................................................................................... 89
Personality disorders .......................................................................................................... 89
81 Contents
Chapter 04: Psychiatric disorders
Anxiety or depression
– mild to moderate
Group 1 Group 2
Without significant May drive and need not May drive and need not
memory or notify DVLA. notify DVLA.
concentration
See Appendix E, page 128 for For other cases, refer to ‘severe’ below.
problems, agitation,
04
medication considerations relevant to See Appendix E, page 128 for
behavioural driving. medication considerations relevant
disturbance or to driving.
suicidal thoughts
Persistent alcohol and/or drug misuse or dependence

■ See Chapter 5, page 88.
■ If psychiatric illness has been associated with substance misuse, continued misuse
contraindicates driving and licensing.
Severe anxiety or depression

Note: effects of severe illness are of greater importance for their relevance to driving than
medication – but see Appendix E, page 126 for additional considerations, on medication.
Group 1 Group 2
Significant memory Must not drive and must Must not drive and must
or concentration notify DVLA. notify DVLA.
problems, agitation,
Particular danger would be posed by Particular danger would be posed by
behavioural those who may attempt suicide at those who may attempt suicide at
disturbance or the wheel. the wheel.
suicidal thoughts Licensing may be granted after 3 Licensing may be granted after
months if: 6 months if:
■ the person has been well and stable ■ the person has been well and stable
■ the person has adhered to previously and
agreed treatment programmes and ■ the person has adhered to previously
■ is not suffering from medicinal side agreed treatment programmes and
effects that would affect alertness or ■ is not suffering from medicinal side
concentration effects that would affect alertness or
concentration
continued
82 Contents
DVLA may need reports from

a specialist in psychiatry.
Driving is usually permitted after
6 months if the anxiety or depression
has been long-standing but symptoms
are under control and if maintenance on
a dosage of psychotropic medication
does not cause impairment.
Psychotic disorder – including acute episode
04
Group 1 Group 2
Must not drive during acute illness Must not drive during acute illness
and must notify DVLA. and must notify DVLA.
Licensing may be considered if all Licensing may be considered if all of
of these conditions are met: these conditions are met:
■ remained well and stable for at ■ remained well and stable for
least 3 months at least 12 months
■ adheres to any agreed treatment plan ■ adheres to any agreed treatment plan
■ free from any medication effects ■ free from any medication effects that
that would impair driving would impair driving
■ subject to a suitable specialist report ■ subject to a favourable report from
being favourable a specialist in psychiatry
A lack of insight which impacts upon A lack of insight which impacts upon
the ability to drive safely would be a the ability to drive safely would be a
bar to licensing. bar to licensing.
Drivers with a history of instability The minimum effective antipsychotic
and/or poor engagement with treatment dosage should be sought, in line with
will be required not to drive for a longer good practice. Drug tolerability should
period before any relicensing. be optimal and not associated with
any deficits that might impair driving,
such as to alertness, concentration or
motor performance.
Established illness with a history
suggesting a likelihood of relapse:
the risk of this needs to be considered
low.
DVLA will normally require the report
of a specialist in psychiatry that
specifically addresses the above
issues as relevant to driving before it
may grant a licence.
83 Contents
Hypomania or mania
For Group 2 bus and lorry driving, in both stable and unstable conditions:
04
■ the minimum effective dosage of any antipsychotic medication should be sought, in
line with good practice. Drug tolerability should be optimal and not associated with
any deficits that might impair driving, such as to alertness, concentration or motor
performance
■ established illness with a history to suggest a likelihood of relapse: the risk of this must
be considered low
Group 1 Group 2
Stable Must not drive and must Must not drive and must
There must be no driving notify DVLA. notify DVLA.
during any acute illness. Licensing may be considered if all Licensing may be considered if all
of these conditions are met: of these conditions are met:
■ remained well and stable for at ■ remained well and stable for at
least 3 months least 12 months
■ adheres to any agreed treatment plan ■ adheres to any agreed treatment plan
■ free from any medication effects that ■ free from any medication effects that
would impair driving would impair driving
■ subject to a favourable report from ■ subject to a favourable report from
a suitable specialist a specialist in psychiatry
bar to licensing. bar to licensing
See note above for both stable and
unstable conditions.
Unstable: 4 or more Must not drive and must Must not drive and must
episodes of significant
mood swing in the
previous 12 months. Licensing may be considered if all Licensing may be considered if all
of these conditions are met: of these conditions are met:
Particular danger would
be posed by driving if ■ remained well and stable for ■ remained well and stable for at
there is hypomania or at least 6 months least 12 months
mania with repeated ■ adheres to any agreed treatment plan ■ adheres to any agreed treatment plan
change of mood. ■ free from any medication effects that ■ free from any medication effects that
In all cases, there must would impair driving would impair driving
be no driving during any ■ subject to a favourable report from ■ subject to a favourable report from
acute illness. a suitable specialist a specialist in psychiatry
continued
84 Contents
bar to licensing. bar to licensing
See note above for both stable and
unstable conditions.
Schizophrenia
– and other chronic relapsing/remitting disorders
04
Group 1 Group 2
There must be no Must not drive and must Must not drive and must
driving during any notify DVLA. notify DVLA.
acute illness
Licensing may be considered if all of Licensing may be considered if all
Driving would be these conditions are met: of these conditions are met:
particularly dangerous ■ remained well and stable for at ■ remained well and stable for at
if psychotic least 3 months least 12 months. A longer period of
symptoms relate ■ adheres adequately to any agreed stability may be required if there is a
to other road users treatment plan history of relapses
■ free from any medication effects that ■ adheres strictly to any agreed
would impair driving treatment plan
■ subject to a suitable specialist report ■ free from any medication effects that
being favourable would impair driving
Continuing symptoms: even ■ subject of a favourable report from
with limited insight, these do not a specialist in psychiatry
necessarily preclude licensing. Further:
However a lack of insight which ■ the minimum effective dosage of any
impacts upon the ability to drive safely antipsychotic medication should be
would be a bar to licensing. sought, in line with good practice.
Symptoms should be unlikely to cause Drug tolerability should be optimal
significant concentration problems, and not associated with any deficits
memory impairment or distraction that might impair driving, such as
while driving. to alertness, concentration or motor
performance
■ established illness with a
history suggesting a likelihood of
relapse: the risk of this must be
considered low
A lack of insight which impacts upon
the ability to drive safely would be a
bar to licensing.
85 Contents
Neurological developmental conditions

Group 1 Group 2
Any neurological May be able to drive but must May be able to drive but must
developmental notify DVLA if condition affects the notify DVLA if condition affects the
conditions including ability to drive safely. ability to drive safely.
attention deficit
A diagnosis of any of these conditions A diagnosis of any of these conditions
hyperactivity disorder
is not in itself a bar to licensing. is not in itself a bar to licensing.
04
(ADHD), autism
spectrum condition and The DVLA must be notified if there The DVLA must be notified if there
other related conditions are any significant issues with are any significant issues with
the following, either singly or in the following, either singly or in
combination, to a degree that would combination, to a degree that would
raise concerns about an individual’s raise concerns about an individual’s
ability to drive safely. These are: ability to drive safely. These are:
■ attention and concentration ■ attention and concentration
■ memory ■ memory
■ behaviour and awareness of how ■ behaviour and awareness of how
this impacts on others this impacts on others
■ ability to regulate emotions ■ ability to regulate emotions
■ ability to make considered decisions ■ ability to make considered decisions
without being impulsive without being impulsive
■ insight and understanding ■ insight and understanding
■ ability to anticipate the actions ■ ability to anticipate the actions
of others of others
■ cognitive flexibility ■ cognitive flexibility
■ sensory processing (increased ■ sensory processing (increased
sensitivity to sensory stimuli for sensitivity to sensory stimuli for
example light, sound, etc) example light, sound, etc)
■ motor coordination and control ■ motor coordination and control
If your patient is diagnosed with a If your patient is diagnosed with a
neurological developmental condition neurological developmental condition
but has passed a driving test, the but has passed a driving test, the
attributes for safe driving will already attributes for safe driving will already
have been demonstrated at that time. have been demonstrated at that time.
The DVLA will only need to be notified The DVLA will only need to be notified
if there is a change to their condition, if there is a change to their condition,
or if you have any concerns around or if you have any concerns around
their ability to drive safely. their ability to drive safely.
The DVLA must be informed if The DVLA must be informed if
prescribed medication or any side prescribed medication or any side
effects of the medication are likely to effects of the medication are likely to
impair safe driving. impair safe driving.
86 Contents
Cognitive impairment (not mild dementia)

Group 1 Group 2
No likely driving May drive and need not May drive and need not
impairment notify DVLA. notify DVLA.
Possible driving It is difficult to assess driving ability It is difficult to assess driving ability
impairment in people with CI. DVLA acknowledges in people with CI. DVLA acknowledges
04
that there are varied presentations and that there are varied presentations and
rates of progression, and the decision rates of progression, and the decision
on licensing is usually based on on licensing is usually based on
medical reports. medical reports.
Considerations include: Considerations include:
■ poor short-term memory, ■ poor short-term memory,
disorientation, and lack of insight disorientation, and lack of insight
and judgement almost certainly and judgement almost certainly
mean not fit to drive mean not fit to drive
■ disorders of attention causing ■ disorders of attention causing
impairment impairment
A formal driving assessment may be A licence may be issued subject
necessary (see Appendix G, page 131). to review.
A licence may be issued subject
to review.

Dementia
– and/or any organic syndrome affecting cognitive functioning
Group 1 Group 2
May be able to drive but must Must not drive and must
It is difficult to assess driving ability Licensing will be refused or revoked.
in people with dementia. DVLA
acknowledges that there are varied
presentations and rates of progression,
and the decision on licensing is usually
based on medical reports.
continued
87 Contents
Considerations include:
■ poor short-term memory,
disorientation, and lack of insight
and judgement almost certainly
mean no fitness to drive
■ disorders of attention cause
impairment
■ in early dementia, when sufficient
skills are retained and progression
is slow, a licence may be issued
subject to annual review
A formal driving assessment may be
04
necessary (see Appendix G, page 131).
Learning disability
Definition of severe learning disability followed by DVLA
Significantly below average general intellectual functioning, accompanied by severe
limitations in adaptive functioning in at least 2 of these areas:
■ communication ■ functional academic skills
■ self-care ■ work
■ home-living ■ leisure
■ social/interpersonal skills ■ health and safety
■ self-direction
Group 1 Group 2
Mild learning May be able to drive but must May be able to drive but must
disability notify DVLA. notify DVLA.
Learning difficulty is Licensing will be granted provided Licensing may be granted provided
not included. Dyslexia, there are no other relevant problems. there are only minor degrees of
dyscalculia, and so on, learning disability and the condition is
are no bar to ordinary DVLA may require an assessment
of adequate functional ability at stable with no medical or psychiatric
Group 1 licences being complications.
awarded after successful the wheel.
driving tests, and the The DVSA driving test is considered
DVLA need not be the arbiter as to whether the condition
informed affects the ability to drive safely.
Severe Must not drive and must Must not drive and must
Licensing will be refused. Licensing will be refused.
88 Contents
Behavioural disorders
– including post-head injury, dissociative seizures
Group 1 Group 2
Severe disturbance Must not drive and must Must not drive and must
from syndrome notify DVLA. notify DVLA.
post-head injury, for
Licensing will be refused or revoked Licensing will be refused or revoked
example
04
if there is serious disturbance – for if there is serious disturbance – for
example, violent behaviour or alcohol example, violent behaviour or alcohol
abuse likely to be a source of danger abuse likely to be a source of danger
at the wheel. at the wheel.
Licensing may be granted after Licensing may be granted if a
medical reports confirm satisfactory specialist confirms satisfactory control
control and stability of behavioural and stability.
disturbances.
Personality disorders
Group 1 Group 2
Severe disturbance May be able to drive but must Must not drive and must
Licensing will be refused or revoked if Licensing will be refused or revoked if
there is likely to be danger at the wheel. there is likely to be danger at the wheel.
Licensing may be granted if Licensing may be given consideration if
behavioural disturbance is: behavioural disturbance is:
■ not related to driving ■ not related to driving
or or
■ not likely to adversely affect driving ■ not likely to adversely affect driving
and road safety and road safety

and
■ a specialist confirms stability
89 Contents
05 Drug or alcohol
misuse or dependence
Alcohol misuse ....................................................................................................................... 91
Alcohol dependence ............................................................................................................ 91
05
Alcohol-related disorders ................................................................................................. 92
Alcohol-related seizure ...................................................................................................... 92
Drug misuse or dependence ........................................................................................... 94
Seizure associated with drug use ................................................................................ 97
90 Contents
Chapter 05: Drug or alcohol misuse and dependence
Alcohol misuse
Guide to definition of misuse
There is no single definition to embrace all the variables within alcohol misuse – but DVLA
offers the following:
“A state that causes, because of consumption of alcohol, disturbance of behaviour,
related disease or other consequences likely to cause the patient, their family or society
present or future harm and that may or may not be associated with dependence.”
The relevant classification code for alcohol misuse is World Health Organization
F10.1 (ICD-10).
05
Group 1 Group 2
Persistent alcohol Must not drive and must Must not drive and must
misuse notify DVLA. notify DVLA.
confirmed by medical Licence will be refused or revoked Licence will be refused or revoked
enquiry and/or evidence until after: until after:
of otherwise unexplained
■ a minimum of 6 months of controlled ■ a minimum of 1 year of controlled
abnormal blood markers
drinking or abstinence, and drinking or abstinence, and
■ normalisation of blood parameters ■ normalisation of blood parameters
Definition of controlled drinking

Drinking within government recommended health guidelines (currently 14 units
per week).
Alcohol dependence
Guide to definition of dependence
There is no single definition to embrace all the variables within alcohol dependence –
but DVLA offers the following:
“A cluster of behavioural, cognitive and physiological phenomena that develop
after repeated alcohol use, including:
■ a strong desire to take alcohol
■ difficulties in controlling its use
■ persistent use in spite of harmful consequences
■ and with evidence of increased tolerance and sometimes a physical

withdrawal state”
Indicators may include any history of withdrawal symptoms, tolerance, detoxification
or alcohol-related seizures.
The relevant classification code for alcohol dependence is World Health Organization
F10.2 (ICD-10).
91 Contents
Group 1 Group 2
Dependence Must not drive and must Must not drive and must
confirmed by notify DVLA. notify DVLA.
medical enquiry
Licence will be refused or revoked Licence will be refused or revoked
Also refer to alcohol until a minimum of 1 year’s abstinence until a minimum of three years’
related seizure below from alcohol consumption has been abstinence from alcohol consumption
attained. has been attained.
Continued licensing will thereafter Continued licensing will thereafter
require ongoing abstinence. require ongoing abstinence.
For both driving groups:

■ licensing will require satisfactory medical reports from a doctor
05
■ DVLA may need to arrange independent medical examination and
blood tests
■ referral to and the support of a consultant specialist may be necessary
Alcohol-related disorders
Group 1 Group 2
Examples Must not drive and must Must not drive and must
■ hepatic cirrhosis notify DVLA. notify DVLA.
with chronic
Licence will be refused or revoked Licence will be refused or revoked until
encephalopathy
until: recovery is satisfactory.
■ alcohol induced ■ recovery is satisfactory
psychosis
■ any other relevant medical standards
■ cognitive impairment
for fitness to drive are satisfied (for
example, Chapter 4, psychiatric
disorders, page 81)
Alcohol-related seizure
Seizure(s) associated with alcohol use may be considered provoked in terms of licensing
(for details see neurological disorders and Appendix B, page 116).
In addition, the relevant standards for any associated alcohol misuse or dependence
should be applied.
92 Contents
High risk offenders

Defined in terms of the alcohol-related driving convictions below, the courts notify
DVLA of high risk offenders.
An independent medical examination will be arranged when an application for licence
reinstatement is received by DVLA. The assessment may include:
■ questionnaire
■
serum CDT assay
■ any further testing indicated
If a licence is awarded, the ’til 70 licence is restored for Group 1 car and motorcycle
driving. Consideration may be given to a Group 2 licence.
05
If a high risk offender has a previous history of alcohol dependence or persistent
misuse but has satisfactory examination and blood tests, a short period licence is
issued for ordinary and vocational entitlement but is dependent on their ability to meet
the standards as specified.
A high risk offender found to have a current history of alcohol misuse or dependence
and/or unexplained abnormal blood test results will have the application refused.
Definition
The high risk offender scheme applies to drivers convicted of the following:
■ one disqualification for driving or being in charge of a vehicle when the level of
alcohol in the body equalled or exceeded either one of these measures:
■ 87.5 mcg per 100 ml of breath
■ 200.0 mg per 100 ml of blood
■ 267.5 mg per 100 ml of urine
■ two disqualifications within the space of 10 years for drink-driving or being in

charge of a vehicle while under the influence of alcohol
■ one disqualification for refusing or failing to supply a specimen for alcohol analysis
■ one disqualification for refusing to give permission for a laboratory test of a

specimen of blood for alcohol analysis
continued
93 Contents
Drug misuse or dependence

The relevant classification codes for drug misuse or dependence are World Health
Organization F11 to F19 inclusive (ICD-10).
The below requirements apply to cases of single-substance misuse or dependence,
whereas multiple problems – including with alcohol misuse or dependence – are not
compatible with fitness to drive or licensing consideration, in both groups of driver.
Group 1 Group 2
Car and motorcycle Bus and lorry
05
Drug group Must not drive and must notify Must not drive and must notify
■ cannabis DVLA with persistent misuse or DVLA with persistent misuse or
■ amphetamines (but dependence. dependence.
see methamphetamine Medical enquiry confirming the Medical enquiry confirming the
drug group below) problem will result in licence being problem will result in licence being
■ ‘ecstasy’ (MDMA) refused or revoked: refused or revoked:
■ ketamine ■ for a minimum of 6 months, ■ for a minimum of 1 year, which must
■ other psychoactive which must be free of misuse or be free of misuse or dependence
substances, including dependence Relicensing will usually require an
LSD and hallucinogens Relicensing may require an independent independent medical assessment and
medical assessment and urine screen urine screen arranged by DVLA.
arranged by DVLA.
94 Contents
Group 1 Group 2
Drug group Must not drive and must notify Must not drive and must notify
■ opiates (for example DVLA with persistent misuse or DVLA with persistent misuse or
heroin, morphine) dependence. dependence.
■ opioids (for example Medical enquiry confirming the Medical enquiry confirming the
codeine) problem will result in licence being problem will result in licence being
■ benzodiazepines refused or revoked for a minimum of refused or revoked for a minimum of
1 year, which must be free of misuse or 3 years, which must be free of misuse
■ synthetic
dependence. or dependence.
benzodiazepines
Relicensing may require an Relicensing will usually require an
■ synthetic cannabinoids independent medical assessment and independent medical assessment and
■ methadone (note on urine screen arranged by DVLA. urine screen arranged by DVLA.
compliance above)
05
■ cocaine
■ methamphetamine
Benzodiazepines
Note on therapy versus
persistent misuse below.
Methadone/
buprenorphine
programmes - see
guidelines below.
Note on methadone/buprenorphine treatment programmes

Group 1
Applicants or drivers complying fully with a consultant or appropriate healthcare practitioner
supervised oral methadone maintenance programme may be licensed subject to favourable
assessment and normally annual medical review. Applicants or drivers on an oral
buprenorphine programme may be considered applying the same criteria. There should be
no evidence of continuing use of other substances including cannabis.
Application may be considered when all of the following conditions can be met:
■ stable on the programme for a minimum of 1 year
■ the treatment programme is supervised by a consultant or specialist GP
■ the treatment is for management of opiate dependence
■ oral/sublingual treatment only (not parenteral) but subcutaneous long-acting

buprenorphine or naltrexone implants may be considered
■ there has been compliance with the programme (adherence to prescription and
appointments, and toxicology testing with sustained stability)
■ no non-prescribed psychoactive drug use during the programme or extra use
of prescribed drugs such as methadone, buprenorphine, benzodiazepines
■ there is no toxicological evidence of drug misuse
■ there is no adverse effect from treatment likely to affect safe driving
■ there is no alcohol misuse or dependence
■ there should be no other disqualifying conditions (as specified in the other chapters of
this guidance) continued
95 Contents
Group 2 and C1/D1

Applicants or drivers complying fully with a consultant or appropriate healthcare practitioner
supervised oral methadone maintenance programme may be considered for an annual
medical review licence, once a minimum 3 year period of stability on the maintenance
programme has been established with favourable random urine tests and assessment.
Expert panel advice will be required in each case.
Application may be considered when all of the following conditions can be met:
■ stable on the programme for a minimum of 3 years
■ the treatment programme is supervised by a consultant or specialist GP
■ the treatment is for management of opiate dependence
■ oral/sublingual treatment only (not parenteral) but subcutaneous long-acting

buprenorphine or naltrexone implants may be considered
05
■ there has been compliance with the programme (adherence to prescription and
appointments, and toxicology testing with sustained stability)
■ no non-prescribed psychoactive drug use during the programme or extra use of
prescribed drugs such as methadone, buprenorphine, benzodiazepines
■ there is no toxicological evidence of drug misuse
■ there is no adverse effect from treatment likely to affect safe driving
■ there is no alcohol misuse or dependence
■ there should be no other disqualifying conditions (as specified in the other chapters
of this guidance)
96 Contents
Seizure associated with drug use

Seizure(s) associated with drug use may be considered provoked In terms of licensing
(for details see neurological disorders, page 16 and Appendix B, page 116).
In addition, the relevant standards for any associated drug misuse or dependence
should be applied.
Relicensed drivers with former drug misuse or dependence should be advised as

part of their after-care that recurrence would mean they must stop driving and must
notify DVLA.
05
97 Contents
06 Visual
disorders
Minimum eyesight standards ......................................................................................... 99
Higher standard of visual acuity for bus and lorry drivers ................................ 99
Minimum standards for field of vision ..................................................................... 100
Higher standards of field of vision for bus and lorry drivers ......................... 100
Cataract .................................................................................................................................. 102
06
Monocular vision ................................................................................................................ 102
Visual field defects ............................................................................................................ 103
Diplopia .................................................................................................................................. 104
Nyctalopia ............................................................................................................................. 104
Colour blindness ................................................................................................................ 104
Blepharospasm ................................................................................................................... 105
Nystagmus ............................................................................................................................ 105
98 Contents
Chapter 06: Visual disorders
Minimum eyesight standards

– all drivers
The law requires that all licensed drivers meet the following eyesight requirements
(including drivers aided by prescribed glasses or contact lenses):
■ in good daylight, able to read the registration mark fixed to a vehicle registered under
current standards
■ at a distance of 20 metres with letters and numbers 79mm high by 50mm wide on
a car registered since 1 September 2001

or
■ at a distance of 20.5 metres with letters and numbers 79mm high by 57mm wide on a
car registered before 1 September 2001

and
■ the visual acuity must be at least Snellen 6/12 with both eyes open or in the only eye
if monocular
06
Any driver unable to meet these standards must not drive and must notify DVLA,
which will refuse or revoke a licence.
The law also requires all drivers to have a minimum field of vision, as set out below.
Bioptic telescope devices are not accepted by DVLA for driving.
Higher standard of visual acuity

– bus and lorry drivers
Group 2 bus and lorry drivers require a higher standard of visual acuity in addition:
■ a visual acuity (using corrective contact lenses where needed) of at least:
■ Snellen 6/7.5 (Snellen decimal 0.8) in the better eye
and
■ Snellen 6/60 (Snellen decimal 0.1) in the poorer eye
■ if glasses are worn to meet the minimum standards, they should have a corrective
power not exceeding +8 dioptres in any meridian of either lens
99 Contents
Minimum standards for field of vision

– all drivers
The minimum field of vision for Group 1 driving is defined in the legislation:
“A field of at least 120° on the horizontal measured using a target equivalent to the white
Goldmann III4e settings.
The extension should be at least 50° left and right. In addition, there should be no
significant defect in the binocular field that encroaches within 20° of the fixation above
or below the horizontal meridian.”
This means that homonymous or bitemporal defects that come close to fixation, whether
hemianopic or quadrantanopic, are not usually acceptable for driving.
If DVLA needs a visual field assessment for determining fitness to drive, it:
■ requires the method to be a binocular Esterman field test
■ may request monocular full field charts in specific conditions
06
■ exceptionally, may consider a Goldmann perimetry assessment carried out to strict criteria
The Secretary of State’s Honorary Medical Advisory Panel for Visual Disorders and Driving
advises that, for an Esterman binocular chart to be considered reliable for licensing, the
false-positive score must be no more than 20%. When assessing monocular charts and
Goldmann perimetry, fixation accuracy will also be considered.
Defect affecting central area only (Esterman within 20 degree radius of fixation)
Only for the purposes of licensing Group 1 car and motorcycle driving:
■ the following are generally regarded as acceptable central loss
■ scattered single missed points
■ a single cluster of up to 3 adjoining points
■ the following are generally regarded as unacceptable (‘significant’) central loss:

■ a cluster of 4 or more adjoining points that is either wholly or partly within the
central 20° area

■ loss consisting of both a single cluster of 3 adjoining missed points up to and
including 20° from fixation, and any additional separate missed points within the
central 20° area
■ any central loss that is an extension of hemianopia or quadrantanopia of size
greater than 3 missed points
Defect affecting the peripheral areas – width assessment

Only for the purposes of licensing Group 1 car and motorcycle driving:
■ the following will be disregarded when assessing the width of field
■ a cluster of up to 3 adjoining missed points, unattached to any other area of defect,
lying on or across the horizontal meridian

■ a vertical defect of only single-point width but of any length, unattached to any other
area of defect, which touches or cuts through the horizontal meridian
continued
100 Contents
Exceptional cases
Group 1 drivers whose previous full driving entitlement was removed because of a field
defect failing to satisfy the standard may be eligible for individual relicensing consideration
as exceptional cases under the following strict criteria:
■ defect must have been
■ present for at least 12 months
■ caused by an isolated event or a non-progressive condition
■ there must be no other condition or pathology regarded as progressive and likely to be

affecting the visual fields (panel’s advice is that certain medical conditions, for example
glaucoma and retinitis pigmentosa, would always be considered as progressive and so
could not be considered as exceptional cases)
■ sight in both eyes
■ no uncontrolled diplopia
■ no other impairment of visual function, including
■ no glare sensitivity, contrast sensitivity or impairment of twilight vision
06
■ clinical confirmation of full functional adaptation
For exceptional cases considered to be potentially licensable under these criteria,
DVLA will then require a satisfactory practical driving assessment at an approved
centre (see Appendix G, page 131).
Static visual field defect

For prospective learner drivers with a static visual field defect, a process is now in
place to apply for a provisional licence. For further information, see ‘Applying for a
provisional licence if you’ve got a static visual field defect’.
Monocular individuals cannot be considered as exceptional cases under the
above criteria.
Higher standards of field of vision

– bus and lorry drivers
The minimum standard for the field of vision is defined by the legislation for Group 2 bus
and lorry licensing as:
■ an uninterrupted measurement of at least 160° on the horizontal plane
■ extensions of at least 70° left and at least 70° right
■ extensions of at least 30° above and at least 30° below the horizontal plane
■ no significant defect within 70° left and 70° right between 30° up and 30° down (it
would be acceptable to have a total of up to 3 missed points, which may or may not be
contiguous*)
■ no defect is present within a radius of the central 30°
■ no other impairment of visual function, including no glare sensitivity, contrast sensitivity

or impairment of twilight vision
(*Points tested in the ‘letterbox’ outside the central radius of 30° from fixation.)
continued
101 Contents
For Group 2 bus and lorry driving, it would be acceptable for a defect on visual field charts
to have an upper limit of a total of 3 missed points – which may be contiguous – within the
letterbox but outside the central 30° radius.
A total of more than 3 missed points, however – even if not contiguous – would not be
acceptable for Group 2 driving because of the higher standards required.
Note that no defects of any size within the letterbox are licensable if a contiguous defect
outside it means the combination represents more than 3 missed points.
Note Exception 1 in ‘Exceptions allowed by older licences’ below.
Clinically apparent visual inattention will be debarring for Group 1 and Group 2.
Cataract
Group 1 Group 2
06
Often safe to drive and may not Often safe to drive and may not
need to notify DVLA. need to notify DVLA.
The minimum standards set out for all The minimum standards for Group 2
drivers above must be met. drivers set out above must be met.
Glare may counter an ability to pass Glare may counter an ability to pass
the number plate test (of the minimum the number plate test (of the minimum
requirements) even when cataracts requirements) even when cataracts
allow apparently appropriate acuities. allow apparently appropriate acuities.
Monocular vision
Group 1 Group 2
Including, for any Must not drive and may need Must not drive and must
reason, making use to notify DVLA. notify DVLA.
of only one eye
For complete loss of vision in one The law bars licensing if in one eye
eye (cases where there is any light there is:
perception in the affected eye are not ■ complete loss of vision or
considered monocular), the driver:
■ corrected acuity falls below Snellen
■ must meet the same visual acuity 3/60 (Snellen decimal 0.05)
and visual field standards as
See also ‘grandfather rights’ below.
binocular drivers
■ may drive only after clinical advice
of successful adaptation to the
condition
Only those monocular people who
fail to meet these requirements are
required to notify DVLA.
102 Contents
Exceptions for visual acuity allowed by older licences (‘grandfather rights’)

The standards for Group 1 car and motorcycle licensing must be met before any of the
following exceptions can be afforded to Group 2 bus and lorry drivers holding older licences.
Visual acuity
Exception 1
A driver must have been awarded a Group 2 bus and lorry licence before 1 March 1992,
and be able to complete a satisfactory certificate of experience, to be eligible.
If the licence was awarded between 2 March 1992 and 31 December 1996, visual acuity
with corrective lenses if needed must be at least 6/9 in the better eye and at least 6/12 in
the other eye; uncorrected visual acuity may be worse than 3/60 in one eye only.
Monocularity
Exception 2
Must have been awarded a Group 2 bus and lorry licence before 1 January 1991, with the
06
monocularity declared before this date.
Exception 3
Drivers with a pre-1997 Group 1 licence who are monocular may apply to renew their
category C1 (vehicles 3.5t to 7.5t). They must be able to meet the minimum eyesight
standards which apply to all drivers and also the higher standard of field of vision for
Group 2 (bus and lorry) drivers.
Visual field defects

Group 1 Group 2
Disorders such as: Must notify DVLA. Must notify DVLA.

■ bilateral glaucoma
The national recommendations for The national recommendations for
■ bilateral retinopathy visual field would need to be met. visual field would need to be met.
■ retinitis pigmentosa See ‘Exceptional cases’ under the Licensing may be awarded if:
and others that produce ‘Minimum standards for field of vision – ■ horizontal visual field is at least 160°
a field defect, including all drivers’ (page 100, at the beginning
■ extension is at least 70° left and
partial or complete of this chapter).
right, and 30° up and down
homonymous
hemianopia/ ■ no defects present within a radius of
quadrantanopia or the central 30°
complete bitemporal
hemianopia.
103 Contents
Diplopia
Group 1 Group 2
Driving may resume after DVLA has Licensing will be refused or revoked
received confirmation that the diplopia permanently in cases of insuperable
is controlled, for example by: diplopia.
■ glasses or Patching is not acceptable for licensing.
■ a patch for which there is an
undertaking to use it while driving
(but note the requirements for
monocular vision above)
Exceptionally, a stable uncorrected
diplopia endured for 6 months or more
may be licensable with the support
06
of a consultant/specialist’s report of
satisfactory functional adaptation.
Nyctalopia
Group 1 Group 2
Driving may be licensed after individual Driving may be licensed after individual
consideration, provided the standards consideration, provided the standards
for visual acuity and field above are met. for visual acuity and field above are met.
Colour blindness
Group 1 Group 2
the DVLA. the DVLA.
104 Contents
Blepharospasm
Group 1 Group 2
Driving is not usually licensed if the Driving is not usually licensed if the
condition is severe and affects vision, condition is severe and affects vision,
even if treated. even if treated.
A consultant/specialist’s opinion will A consultant/specialist’s opinion will
be sought by DVLA. be sought by DVLA.
Driving may be licensed if the Driving may be licensed if the
condition is mild, subject to return condition is mild, subject to return
of satisfactory medical reports. of satisfactory medical reports.
Control of mild blepharospasm with Control of mild blepharospasm with
botulinum toxin may lead to licensing botulinum toxin may lead to licensing
if the treatment does not produce side if the treatment does not produce side
06
effects that are otherwise disqualifying, effects that are otherwise disqualifying,
such as uncontrollable diplopia. such as uncontrollable diplopia.
DVLA should be informed of any DVLA should be informed of any
change – and any deterioration change – and any deterioration
in condition must be notified. in condition must be notified.
Nystagmus
Group 1 Group 2
DVLA need not be notified of DVLA need not be notified of

nystagmus providing the vision nystagmus providing the vision
standards for driving are achieved standards for driving are achieved
and providing any associated medical and providing any associated medical
condition is declared. condition is declared.
105 Contents
07 Renal and respiratory

disorders
Chronic renal failure ......................................................................................................... 107
All other renal disorders ................................................................................................. 107
Disorders of respiratory function ............................................................................... 108
Primary lung carcinoma ................................................................................................. 108
07
106 Contents
Chapter 07: Renal and respiratory disorders
Chronic renal failure

Group 1 Group 2
Continuous May drive and need not notify May drive and need not notify
ambulatory DVLA unless the condition is DVLA unless the condition is
peritoneal associated with a disability likely associated with a disability likely
dialysis (CAPD) to affect driving and/or significant to affect driving and/or significant
or haemodialysis electrolyte disturbance (likely to result electrolyte disturbance (likely to result
in clinical symptoms). in clinical symptoms).
Individual assessment is required
for relicensing.
All other renal disorders

Group 1 Group 2
07
DVLA unless the condition is DVLA unless the condition is
associated with a disability likely to associated with a disability or any
affect driving. significant symptoms likely to
affect driving.
107 Contents
Chapter 07: Renal and respiratory disorders
Disorders of respiratory function

– including asthma and COPD
Group 1 Group 2
DVLA unless any complications are DVLA unless any complications are
associated with: associated with:
■ cough syncope ■ cough syncope
■ disabling dizziness ■ disabling dizziness
■ fainting ■ fainting
or or
■ loss of consciousness ■ loss of consciousness
Such sequelae need reference to Such sequelae need reference to
requirements under ‘Transient loss requirements under ‘Transient loss
of consciousness’ (from page 21 of of consciousness’ (from page 21 of
Chapter 1, neurological disorders). Chapter 1, neurological disorders).
See also cough syncope in Chapter 1, See also cough syncope in Chapter 1,
page 26. page 26.
07
Obstructive sleep apnoea
Refer to guidance concerning this condition under ‘excessive sleepiness’ (page 108)
in Chapter 8, miscellaneous conditions.
Primary lung carcinoma

Group 1 Group 2
May drive and need not notify Must not drive and must
DVLA unless there is cerebral notify DVLA.
metastasis (refer to malignant brain Only those drivers with non-small cell
tumours, page 34 of Chapter 1, lung cancer staged T1 N0 M0 may be
neurological disorders). considered individually for licensing.
Other lung tumours require no
driving for 1 year following definitive
treatment. Subsequent licensing
requires:
■ satisfactory treatment success
■ no brain scan evidence of
intracranial metastases (refer to
malignant brain tumours, page 34
of Chapter 1, neurological disorders)
108 Contents
08 Miscellaneous
conditions
Excessive sleepiness ....................................................................................................... 110
Profound deafness ............................................................................................................ 111
Cancers .................................................................................................................................. 111
Acquired immune deficiency syndrome (AIDS)
and HIV infection ................................................................................................................ 112
Age-related fitness to drive .......................................................................................... 112
Transplant .............................................................................................................................. 113
Devices or implants .......................................................................................................... 113
Cognitive decline or impairment ................................................................................ 114
Cognitive disability ............................................................................................................ 114
Driving after surgery ........................................................................................................ 114
08
Temporary medical conditions .................................................................................... 113
Fractures ................................................................................................................................ 115
Medication effects ............................................................................................................. 116
109 Contents
Chapter 08: Miscellaneous conditions
Excessive sleepiness
– including obstructive sleep apnoea syndrome
‘Excessive sleepiness’ having, or likely to have, an adverse effect on driving includes:

■
obstructive sleep apnoea syndrome of any severity
■
any other condition or medication that may cause excessive sleepiness
n see also guidance on Primary/central hypersomnias, including narcolepsy
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, DVLA will accept results of equivalent objective tests.
The ‘Tiredness can kill’ leaflet (INF159) is for drivers concerned about excessive sleepiness.
Group 1 Group 2
Excessive sleepiness Must not drive. Must not drive.
due to a medical
Driving may resume only after Driving may resume only after
condition (see
satisfactory symptom control. satisfactory symptom control.
relevant chapter)
If symptom control cannot be If symptom control cannot be
including mild
achieved in three months DVLA achieved in three months DVLA
obstructive sleep must be notified. must be notified.
apnoea syndrome
08
(AHI below 15) or
medication.
Excessive sleepiness Must not drive and must Must not drive and must
due to obstructive notify DVLA. notify DVLA.
sleep apnoea
Subsequent licensing will require: Subsequent licensing will require:
syndrome – moderate
and severe:
■ control of condition ■ control of condition
■ AHI 15 to 29 (moderate)
■ sleepiness improved ■ sleepiness improved
■ AHI 30 or more
■ treatment adherence ■ treatment adherence
(severe) on the DVLA will need medical confirmation DVLA will need medical confirmation
apnoea-hypopnoea of the above, and the driver must of the above, and the driver must
index or equivalent confirm review to be undertaken confirm review to be undertaken
sleep study measure every three years at the minimum. annually at the minimum.
Excessive sleepiness Must not drive. Must not drive.

due to suspected
Driving may resume only after Driving may resume only after
obstructive sleep
satisfactory symptom control. satisfactory symptom control.
apnoea syndrome.
If symptom control cannot be If symptom control cannot be
achieved in three months DVLA achieved in three months DVLA
must be notified. must be notified.
See above when diagnosis See above when diagnosis
is confirmed. is confirmed.
110 Contents
Profound deafness
Group 1 Group 2
May drive and need not Must be assessed but may not
notify DVLA. need to notify 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 Group 2
08
In both driving groups,

Must be assessed but may Must be assessed but may not
fitness to drive is
not need to notify DVLA. need to notify DVLA.
affected by the risk
of seizure. If there is a likelihood of cerebral Licensing requires specific
metastasis and seizure, DVLA must consideration of the likelihood of
All cases of eye cancer
be notified. cerebral metastasis and seizure,
must meet the minimum
There must be no significant and there must be no complications,
requirements for vision
complication relevant to driving, such such as:
(Chapter 6, page 98).
as: ■ specific limb impairment, for
■ specific limb impairment, for example due to bone tumour,
example due to bone tumour, primary or secondary
primary or secondary ■ general impairment, for example due
■ general impairment, for example due to advanced malignancy producing
to advanced malignancy producing symptoms such as general
symptoms such as general weakness weakness or cachexia that affects
or cachexia that affects driving driving
The effects of any cancer treatment The effects of any cancer treatment
must also be considered – the generally must also be considered – the generally
debilitating effects of chemotherapy debilitating effects of chemotherapy
and radiotherapy in particular. and radiotherapy in particular.
111 Contents
Acquired immune deficiency syndrome (AIDS)

and HIV infection
HIV infection without AIDS
If there is no AIDS-defining illness, individuals with HIV may drive and do not need to
inform the DVLA of their status.
Group 1 Group 2
AIDS diagnosed May drive but must notify DVLA. May drive but must notify DVLA.
Licensing may be granted for medical Licensing will be considered individually.
review after 1, 2 or 3 years if enquiries Eligibility will require no symptoms
from the DVLA find no disability likely likely to affect driving and the
to affect driving. maintenance of a CD4 count
of 200 cells/microlitre for at
least 6 months.
Age-related fitness to drive
08
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.
DVLA has doctors ready to provide guidance to healthcare professionals. See contact
details on page 14.
continued
112 Contents
Group 1 Group 2
Older age When drivers reach the age of 70, Bus and lorry drivers:
they must confirm to DVLA that they ■ must make fresh licence applications
have no medical disability. every 5 years from the age of 45
Drivers over 70 receive a licence ■ annually from the age of 65
for 3 years after fitness to drive has
Each application must be accompanied
been declared, to include satisfactory
by medical confirmation of satisfactory
completion of medical questions in
fitness to drive.
the application.
Transplant
Group 1 Group 2
May drive and need not May drive and need not
Except: there must be no other, or Except: there must be no other, or
08
underlying condition that requires any underlying condition that requires any
restriction or notification to DVLA. restriction. Failing this, DVLA must
be notified and may require individual
assessment.
Devices or implants
Group 1 Group 2
May drive and need not May drive and need not
Except: there must be no other, or Except: there must be no other, or
underlying condition that requires any underlying condition that requires any
restriction or notification to DVLA. restriction. Failing this, DVLA must
be notified and may require individual
assessment.
113 Contents
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 (Appendix G, page 131) 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:
■ visiospatial deficits, 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 Group 2
Impairment of cognitive functioning is Impairment of cognitive functioning is
not usually compatible with the driving not usually compatible with the driving
08
of these vehicles. Mild cognitive of these vehicles. Mild cognitive
disability may be compatible with safe disability may be compatible with safe
driving – individual assessment will driving – individual assessment will
be required. 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 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 the effects of the 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.
114 Contents
Temporary medical conditions

Drivers generally do not need to notify 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 DVLA needs to be notified, the healthcare
professional should advise the patient to contact 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’, page 114)
■ 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 DVLA of a fracture, but if recovery post-fracture is
prolonged for more than 3 months, the treating clinician should offer advice on a safe
08
time to resume driving.
115 Contents
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
08
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 (page 81), and Chapter 5, drug or alcohol
misuse and dependence (page 90).
116 Contents
Appendix A: The legal basis for the medical standards
Appendix A
The legal basis for the medical standards
The Secretary of State for Transport, acting through DVLA, has the responsibility of ensuring
all licence holders are fit to drive.
The legal basis of fitness to drive in the UK lies in the following legislation:
■ The Road Traffic Act 1988
■ The Motor Vehicles (Driving Licences) Regulations 1999 (as amended)
According to Section 92 of the Road Traffic Act 1988:
■ A relevant disability is any condition which is either prescribed in regulations or any
other disability where driving is likely to be a source of danger to the public. A driver
who is suffering from a relevant disability must not be licensed, but there are some
prescribed disabilities where licensing is permitted provided certain conditions are met.
■ Prospective disabilities are any medical conditions that, because of their progressive
or intermittent nature, may develop into relevant disabilities in time. Examples are
Parkinson’s disease and early dementia. A driver with a prospective disability may
be granted a driving licence for up to 5 years, after which renewal requires further
medical review.
Sections 92 and 94 of the Road Traffic Act 1988 also cover drivers with physical disabilities
who require adaptations to their vehicles to ensure safe control. These adaptations must be
coded and shown on the licence. See Appendix F, disabilities and vehicle adaptations
(page 130) and Appendix G, Mobility Centres and Driving Assessment Centres (page 131).
‘Serious neurological disorders’
A
The law requires that driving licences shall not be issued to, nor renewed for, applicants with
serious neurological disorders, unless supported by the applicant’s doctor.
A serious neurological disorder is defined for the purposes of driver licensing as any
condition of the central or peripheral nervous system that has led, or may lead, to functional
deficiency (sensory, including special senses, motor, and/or cognitive deficiency), and that
could affect ability to drive.
When DVLA evaluates the licensing of these applicants, it will consider the functional status
and risk of progression. A short-term licence for renewal after medical review is generally
issued whenever there is a risk of progression.
Further information relating to specific functional criteria is found in the following chapters:
■ Chapter 1, neurological disorders (page 16)
■ Chapter 4, psychiatric disorders (page 81)
■ Chapter 6, visual disorders (page 98)
■ Chapter 8, miscellaneous conditions – excessive sleepiness (page 110).
117 Contents
Appendix B: Epilepsy regulations and further guidance
Appendix B
Epilepsy and seizure rules and further guidance
The legislation governing drivers who experience a seizure.

The following 2 boxes extract the paragraphs from regulations 72 and 73 of the Motor
Vehicle (Driving Licences) Regulations 1999 (as amended) that govern the way in which
epilepsy is ‘prescribed’ as a ‘relevant’ disability for Group 1 or Group 2 drivers (also see
Appendix A, the legal basis for the medical standards, page 117).
Regulations 72
(2) Epilepsy is prescribed for the purposes of section 92(2) of the Traffic Act 1988 as
a relevant disability in relation to an applicant for, or a holder of, a Group 1 licence
who has had two or more epileptic seizures during the previous five year period.
(2A) Epilepsy is prescribed for the purposes of section 92(4)(b) of the Traffic Act 1988
in relation to an applicant for a Group 1 licence who satisfies the conditions set
out in paragraph (2F) below and who has either:
(a) been free from any unprovoked seizure during the period of one year
immediately preceding the date when the licence is granted
or
(b) during that one year period has suffered no unprovoked seizure other than
a permitted seizure.
(2B) A permitted seizure for the purposes of paragraph (2A)(b) is:
(a) a seizure – which can include a medication-adjustment seizure – falling within
only one of the permitted patterns of seizure
or
(b) a medication-adjustment seizure, where:
B
(i) that medication-adjustment seizure does not fall within a permitted pattern
of seizure
(ii) previously effective medication has been reinstated for at least 6 months
immediately preceding the date when the licence is granted
(iii) that seizure occurred more than 6 months before the date when the licence
is granted; and
(iv) there have been no other unprovoked seizures since that seizure
or
(c) a seizure occurring before a medication-adjustment seizure permitted under
sub-paragraph (b) where:
(i) that earlier seizure has, to that point, formed part of only one permitted
pattern of seizure and had occurred prior to any medication-adjustment
seizure not falling within the same permitted pattern
or
(ii) it is a medication-adjustment seizure, which was not followed by any other
type of unprovoked seizure, except for another medication-adjustment
seizure.
continued
118 Contents
(2C) A permitted pattern of seizure for the purposes of paragraph (2B) is a pattern
of seizures:
(a) occurring during sleep, where:
(i) there has been a seizure while asleep more than one year before the date
when the licence is granted
(ii) there have been seizures only while asleep between the date of that seizure
while asleep and the date the licence is granted
and
(iii) there has never been an unprovoked seizure while awake
or
(b) occurring during sleep, where:
(i) there has been a seizure while asleep more than three years before the date
when the licence is granted;
(ii) there have been seizures only while asleep between the date of that seizure
while asleep and the date the licence is granted
and
(iii) there is also a history of unprovoked seizure while awake, the last of which
occurred more than 3 years before the date when the licence is granted
or
(c) without influence on consciousness or the ability to act, where:
(i) such a seizure has occurred more than 1 year before the date when the
licence is granted
(ii) here have only been such seizures between the date of that seizure and the
date when the licence is granted
and
(iii) there has never been any other type of unprovoked seizure.
(2D) An isolated seizure is prescribed for the purposes of section 92(2) of the Traffic
Act 1988 as a relevant disability in relation to an applicant for, or a holder of, a
B
Group 1 licence:
(a) in a case where there is an underlying causative factor that may increase future
risk, where such a seizure has occurred during the previous 1 year period
and
(b) in any other case, where such a seizure has occurred during the previous
6 month period.
continued
119 Contents
(2E) An isolated seizure is prescribed for the purposes of section 92(4)(b) of the
Traffic Act 1988 in relation to an applicant for a Group 1 licence, who:
(a) (i) in a case where there is an underlying causative factor that may increase
future risk, has had such a seizure more than one year immediately before
the date when the licence is granted
and
(ii) in any other case, has had such a seizure more than 6 months immediately
before the date when the licence is granted
(b) has had no other unprovoked seizure since that seizure
and
(c) satisfies the condition set out in paragraph (2F).
(2F) The conditions are that:
(a) so far as is predictable, the applicant complies with the directions regarding
treatment for epilepsy or isolated seizure, including directions as to regular
medical check-ups made as part of that treatment, which may from time to
time be given by a registered medical practitioner or one of the clinical team
working under the supervision of that registered medical practitioner
(b) if required to do so by the Secretary of State, the applicant has provided a
signed declaration agreeing to observe the condition in sub-paragraph (a)
(c) if required by the Secretary of State, there has been an appropriate medical
assessment by a registered medical practitioner
and
(d) the Secretary of State is satisfied that the driving of a vehicle by the applicant in
accordance with the licence is not likely to be a source of danger to the public.
Regulations 73 B
(8) Epilepsy is prescribed for the purposes of section 92(2) of the Traffic Act as a
relevant disability in relation to an applicant for, or a holder of, a Group 2 licence,
where two or more epileptic seizures have occurred, or that person has been
prescribed medication to treat epilepsy, during the previous ten year period.
(8A) Epilepsy is prescribed for the purposes of section 92(4)(b) of the Traffic Act 1988
in relation to an applicant for a group 2 licence who:
(a) in the case of a person whose last epileptic seizure was an isolated seizure
satisfies the conditions in paragraph (8C) and (8D)
or
continued
120 Contents
(b) in any other case, satisfies the conditions set out in paragraph (8D) and who,
for a period of at least 10 years immediately preceding the date when the
licence is granted has:
(i) been free from any epileptic seizure
and
(ii) has not been prescribed any medication to treat epilepsy.
(8B) An isolated seizure is prescribed for the purposes of section 92(2) of the Traffic
Act 1988 as a relevant disability, in relation to an applicant for, or a holder of, a
Group 2 licence, where during the previous 5 year period, such a seizure has occurred,
or that person has been prescribed medication to treat epilepsy or a seizure.
(8C) An isolated seizure is prescribed for the purposes of section 92(4)(b) of the
Traffic Act 1988 in relation to an applicant for a Group 2 licence who satisfies the
conditions set out in paragraph (8D) and who, for a period of at least five years
immediately preceding the date when the licence is granted:
(a) has been free from any unprovoked seizure
and
(b) has not been prescribed medication to treat epilepsy or a seizure.
(8D) The conditions are that:
(a) if required by the Secretary of State, there has been an appropriate medical
assessment by a neurologist
and
(b) the Secretary of State is satisfied that the driving of a vehicle by the applicant, in
accordance with the licence, is not likely to be a source of danger to the public.
Withdrawal of epilepsy medication

This guidance relates only to epilepsy treatment.
B
During the therapeutic procedure of epilepsy medication being withdrawn by a medical
practitioner, the risk of further epileptic seizures should be noted from a medicolegal point of view.
If an epileptic seizure does occur, the patient will need to meet the medical standards before
resuming driving and will need to be counselled accordingly.
It is clearly recognised that withdrawal of epilepsy medication is associated with a risk of
seizure recurrence. A number of studies have shown this, including a randomised study
of withdrawal in patients in remission conducted by the Medical Research Council’s study
group on epilepsy drug withdrawal. This study showed a 40% increased risk of seizure
associated with the first year of withdrawal compared with continued treatment.
The Secretary of State for Transport’s Honorary Medical Advisory Panel on Driving and
Disorders of the Nervous System states that patients should be warned of the risk they run,
both of losing their driving licence and of having a seizure that could result in a road traffic
accident.
The Advisory Panel states that drivers should usually be advised not to drive from the start of
the withdrawal period and for 6 months after treatment cessation – it considers that a person
remains as much at risk of seizure during the withdrawal as during the following 6 months.
121 Contents
This advice may not be appropriate in every case, however. One specific example is
withdrawal of anticonvulsant medication when there is a well-established history of seizures
only while asleep.
In such cases, any restriction on driving is best determined by the physicians concerned, after
considering the history. It is the patient’s legal duty to comply with medical advice on driving.
It is important to remember that the driver licensing rules remain relevant in cases of
medication being omitted as opposed to withdrawn, such as on admission to hospital.
For changes of medication, for example due to side effect profiles, the following general
advice is applicable:
■ When changing from one medication to another and both would be reasonably
expected to be equally efficacious, then no period of time off driving is recommended.
■ When the new medication is felt to be less efficacious than the previous medication,
the 6 months off driving period is recommended. This time period would start from the
end of the change over period.
Provoked seizures
To be considered a provoked seizure, the seizure must be attributable solely to a
recognisable provoking cause and that causative factor must be reliably avoidable. It should
be clear that the seizure has been provoked by a stimulus that does not convey a risk of
recurrence. Driving will usually need to cease for 6 months (group 1) or up to 5 years (group
2) following a provoked seizure. For Group 2 driving if evidence can be provided to show
that an individual is at a less than 2% annual risk of having a further seizure before 5 years
DVLA would be pleased to receive and consider this.
Doctors may wish to advise patients that the likely total period of time they will be
required by DVLA not to drive will be extended if there is a previous history of unprovoked
seizure or evidence of pre-existing cerebral pathology (e.g. longstanding cerebral lesion,
epileptic activity on EEG or evidence of fixed neurological deficit), that increases the risk of
further seizures.
In the absence of any previous seizure history or previous cerebral pathology, the following
B
seizures may also be treated as provoked:
■ convulsive syncope due to cardiovascular cause
■ seizure in the first week following a head injury
■ seizure in the first week following a stroke, TIA or spontaneous acute subdural haematoma
■ seizure during, or in the first week following, intracranial surgery
■ seizure associated with severe electrolyte/biochemical disturbance (including

hypoglycaemia) documented within 24 hours of specific biochemical or haematologic
abnormalities,
■ seizure associated with drug or alcohol intoxication or withdrawal, or exposure to
well-defined epileptogenic drugs.
The following provoked seizures are excepted and do not require driving to cease,
although the relevant medical standards for the underlying condition will have to be met:
■ seizures occurring at the very moment of impact of a head injury
■ eclamptic seizures
■ seizures provoked by electroconvulsive therapy.
122 Contents
Appendix C: Cardiovascular considerations
Appendix C
Cardiovascular considerations
Group 1 car and motorcycle and Group 2 bus and lorry entitlements
Medication
If drug treatment for any cardiovascular condition is required, any adverse effects likely
to affect safe driving will necessitate the licence being refused or revoked.
Group 2 bus and lorry entitlement only

Licence duration
A bus or lorry licence issued after cardiac assessment – usually for ischaemic or untreated
heart valve disease – will usually be short-term, for a maximum licence duration of 3 years,
and licence renewal will require satisfactory medical reports.
Exercise tolerance testing

DVLA no longer requires regular anti-anginal medication (i.e., nitrates, beta blockers,
calcium channel blockers, nicorandil, ivabradine and ranolazine to be stopped prior to
exercise tolerance testing. The requirements for exercise evaluation are:
1. The test must be on a bicycle (cycling for 10 minutes with 20 W per minute
increments, to a total of 200 W) or treadmill.
2. The patient should be able to complete 3 stages of the standard Bruce protocol
or equivalent safely, while remaining free of signs of cardiovascular dysfunction, viz:
■ angina pectoris
■ syncope
■ hypotension
■ sustained ventricular tachycardia.
3. There must be no electrocardiographic ST segment shift (usually of not more than 2

mm horizontal or down-sloping) that is interpreted by a cardiologist as indicative of
myocardial ischaemia, either during exercise or the recovery period.
C
4. When undertaken as part of medical enquiries regarding hypertrophic cardiomyopathy
it is probable that pre-existing baseline ST segment changes will be present. In such
cases it is not possible to interpret the significance of any new changes occurring during
exercise. The test in this situation is being undertaken as a marker of exercise capacity.
5. Should atrial fibrillation develop de novo during exercise testing, the licensing
requirements will be the same as for individuals with pre-existing atrial fibrillation – that
is, provided all the DVLA exercise tolerance test criteria above are met, licensing will
be subject to echocardiogram and confirmation of left ventricular ejection fraction of at
least 40%.
DVLA will require exercise evaluation at regular intervals not to exceed 3 years if there is
established coronary heart disease.
123 Contents
Chest pain of uncertain cause (angina not yet excluded)

Exercise testing should be performed as outlined above.
Individuals with a locomotor or other disability who cannot undergo or comply with the
exercise test requirements will require a gated myocardial perfusion scan or stress echo
study accompanied when required by specialist cardiological opinion.
Stress myocardial perfusion scan or stress echocardiography

When DVLA requires these imaging tests, the relevant licensing standards are as follows.
LV ejection fraction is 40% or more:
■ no more than 10% of the left ventricular myocardium is affected by reversible ischaemic
change on myocardial perfusion imaging
or
■ no more than one segment is affected by reversible ischaemic change on stress
echocardiography.
Full DVLA protocol requirements for these tests are available on request (see contact details
on page 14).
Coronary angiography
For licensing purposes, DVLA considers functional implication to be more predictive than
anatomical findings in coronary artery disease. ‘Predictive’ refers to the risk of an infarct
within 1 year. Grafts are considered as ‘coronary arteries’.
For this reason, exercise tolerance testing and, where necessary, myocardial perfusion
imaging or stress echocardiography are the investigations of relevance (outlined above)
with the standards as indicated to be applied.
Angiography is therefore not commissioned by DVLA.
If there is a conflict between the results of the functional test and a recent angiography, the
case will be considered individually. Licensing will not normally be granted, however, unless
the coronary arteries are unobstructed or the stenosis is not flow-limiting. The LV ejection
fraction must also be at least 40%.
C
Marfan syndrome: aortic root replacement

DVLA will refuse or revoke a Group 2 (bus or lorry) licence if there has been:
■ emergency aortic root surgery
■ elective aortic root surgery associated with complications or high risk factors – for
example, aortic root, valve and arch (including de-branching) surgery
124 Contents
A bus or lorry licence for annual review may be issued after elective aortic root replacement
surgery provided:
■ surgery is successful without complications
■ there is satisfactory regular specialist follow-up
■ no evidence of suture-line aneurysm postoperatively and on 2-yearly MRI or CT
surveillance following valve-sparing surgery for root replacement plus valve replacement
Group 2 licensing following elective external aortic support procedures will require
individual consideration. Continued licensing thereafter will require regular clinical
review, including MRI imaging one year after surgery and every 3 years thereafter.
Severe aortic stenosis (to include sub-aortic and supravalvular stenosis)

‘Severe’ is defined (European Society of Cardiology guidelines) as:
■ aortic valve area – less than 1cm²
or
– less than 0.6cm²/m² body surface area (BSA)
■ mean aortic pressure gradient – greater than 40mmHg
■ maximum jet velocity – greater than 4 metres/second.
125 Contents
Introduction of the ESC HCM Risk-SCD Calculator

This calculator is recommended by the European Society of Cardiology to assess Sudden
Cardiac Death (SCD) risk in hypertrophic cardiomyopathy (HCM) patients and to assign
patients into low, intermediate or high risk categories. The HCM risk categories for SCD
have been defined as low risk (5 year risk of SCD less than 4%), intermediate risk (5 year
risk of SCD 4 to 6%) and high risk (5 year risk of SCD equal to or greater than 6%).
Classifications of congenital heart disease complexity

Refer to table 4 for the classification of congenital heart disease complexity.
126 Contents
Appendix D: INF188/2 leaflet ‘Information for drivers with diabetes’ and INF294 leaflet
‘A guide to insulin treated diabetes and driving’
Appendix D
INF188/2 leaflet ‘Information for drivers with diabetes’ and INF294
leaflet ‘A guide to insulin treated diabetes and driving’
continued
127 Contents
Appendix E: Important notes concerning psychiatric disorders
Appendix E
Important notes concerning psychiatric disorders
All mental health symptoms must be considered

Any psychiatric condition that does not fit neatly into the classifications in Chapter 4 will
need to be reported to DVLA if it is causing or is considered likely to cause symptoms that
would affect driving.
Such symptoms include, for example:
■ any impairment of consciousness or awareness
■ any increased liability to distraction
■ or any other symptoms affecting the safe operation of the vehicle
The patient should be advised to declare both the condition and the symptoms of concern.
It is the relationship of symptoms to driving that is of importance.
The law sets out the minimum medical standards of fitness to drive and the requirements
for mental health in broad terms state that:
■ there is a clear distinction between the standards for Group 1 car and motorcycle, and
Group 2 bus and lorry licensing. The standards for the latter are more stringent because
of the size of the vehicles and the greater amounts of time spent at the wheel by
occupational drivers
■ severe mental disorder is a prescribed disability for the purposes of section 92 of the
Road Traffic Act 1988. Regulations define “severe mental disorder” as including mental
illness, arrested or incomplete development of the mind, psychopathic disorder, and
severe impairment of intelligence or social functioning
■ the standards of fitness to drive must reflect, not only the need for
an improvement in the mental state, but also a period of stability, such that the risk
of relapse can be assessed should the patient fail to recognise any deterioration
■ misuse of or dependence on alcohol or drugs are cases that require consideration
of the standards in Chapter 5 (page 90) in addition to those for psychiatric disorders
in Chapter 4 (page 81)
Medications
Section 4 of the Road Traffic Act 1988 does not differentiate between illicit and prescribed drugs.
Any person driving or attempting to drive on a public highway or other public place while
unfit due to any drug is liable for prosecution.
■ All drugs with an action on the central nervous system can impair alertness,
concentration and driving performance.
E
■ This is of particular relevance at the initiation of treatment, or soon after, and also when
dosage is being increased. Anyone who is adversely affected must not drive.
■ It should be taken into account when planning the treatment of a patient who is a
professional driver that the older tricyclic antidepressants can have pronounced
anticholinergic and antihistaminic effects, which may impair driving, whereas the
more recently developed antidepressants may have fewer such effects.
128 Contents
Appendix E: Important notes concerning psychiatric disorders
■ Antipsychotic drugs, including depot preparations, can cause motor or extrapyramidal

effects as well as sedation or poor concentration. These effects, either alone or in
combination, may be sufficient to impair driving, and careful clinical assessment is
required.
■ The epileptogenic potential of psychotropic medication should be given particular
consideration in patients who are professional drivers.
■ Benzodiazepines are the psychotropic medications most likely to impair
driving performance – the long-acting compounds in particular – and alcohol will
potentiate effects.
■ Doctors have a duty of care to advise their patients of the potential dangers of
adverse effects from medications and their interactions with other substances,
especially alcohol.
Electroconvulsive therapy
The likely severity of the underlying condition requiring electroconvulsive therapy (ECT)
means the driver should be advised that they must notify DVLA.
Electroconvulsive therapy is usually employed in the context of an acute intervention for
a severe depressive illness or, less commonly, as longer-term maintenance therapy.
In both courses, it is the severity of the underlying mental health condition that is of prime
importance to the determination of whether driving may be permitted.
A seizure induced by ECT is regarded as provoked for the purposes of fitness to drive
and is not a bar to licensing and driving – under both Group 1 car and motorcycle, and
Group 2 bus and lorry.
The concerns for driving are:
■ severity of the underlying illness requiring ECT treatment
■ potential cognitive or memory disturbances associated with both the underlying
depression and the ECT therapy.
Driving must stop during an acute course of treatment with ECT and is not permitted
until the relevant medical standards and observation periods associated with underlying
conditions have been met, as set out in Chapter 4 (page 81) and with respect to any other
mental health symptoms or psychiatric conditions that do not fit neatly into classifications.
Again, this guidance must stress that the underlying condition and response to treatment
are what determine licensing and driving.
Where ECT is used as maintenance treatment with a single treatment sometimes given
weeks apart there may be minimal or no symptoms. This would not affect driving or
licensing providing there is no relapse of the underlying condition.
Driving must stop for 48 hours following the administration of an anaesthetic agent.
E
129 Contents
Appendix F: Disabilities and vehicle adaptations
Appendix F
Disabilities and vehicle adaptations

Driving often remains possible with certain adjustments for a disability, whether for a static
and progressive disorder or a relapsing one. These vehicle modifications may be needed for:
■ permanent limb and spinal disabilities – for example, amputation, hemiplegia, cerebral
palsy, ankylosing spondylitis, or severe arthritis (especially with pain)
■ chronic neurological disorders – for example, multiple sclerosis, Parkinson’s disease,
motor neurone disease, or peripheral neuropathy
Vehicle adaptations range from simple automatic transmission for many disorders, to sophisticated
modifications such as joysticks and infrared controls for people with severe disabilities.
DVLA will need to know about a disability and whether any controls require modification,
and will ask the patient to complete a simple questionnaire.
The driving licence is coded to reflect any vehicle modifications.
Assessment centres offer people advice about driving with a disability (these are listed
in Appendix G (page 131)).
Note that a person in receipt of the mobility component of Personal Independence
Payment (PIP) can hold a driving licence from 16 years of age. (A person can’t apply for
PIP until their 16th birthday.)

Some disabilities, if mild and non-progressive, may be compatible with driving large vehicles.
DVLA needs to be notified and will require an individual assessment.
Mobility scooters and powered wheelchairs

Users of Class 2 or 3 mobility vehicles – which are limited to 4 mph or 8 mph respectively
– are not required to hold a driving licence, and they do not need to meet the medical
standards for driving motor vehicles. DVLA recommends the following, however:
■ individuals with a medical condition that may affect their ability to drive these mobility
vehicles should consult their GP first
■ users should be able to read a car number plate from a distance of 12.3 metres.
More details are at GOV.UK – see Mobility scooters and powered wheelchairs: the rules.
F
130 Contents
Appendix G: Mobility Centres and Driving Assessment Centres
Appendix G
Mobility Centres and Driving Assessment Centres
Find a centre on the Driving Mobility website.
http://www.drivingmobility.org.uk/find-a-centre/
continued
G
131 Contents
Index
INDEX
A
Abscess (intracerebral) Arachnoid cysts
Chapter 1 (neurological disorders) Chapter 1 (neurological disorders)
Acoustic neuroma/schwannoma Arrhythmias

Chapter 1 (neurological disorders) Chapter 2 (cardiovascular disorders)
Acuity Arrhythmogenic right ventricular

Chapter 6 (visual disorders) cardiomyopathy (ARVC)
Chapter 2 (cardiovascular disorders)
Acute coronary syndromes
Chapter 2 (cardiovascular disorders) Arteriovenous malformation
Chapter 1 (neurological disorders)
Acute encephalitic illness and meningitis
Chapter 1 (neurological disorders) Asperger’s syndrome
Chapter 4 (psychiatric disorders)
Acute psychotic disorders of any type
Chapter 4 (psychiatric disorders) Asthma
Chapter 7 (renal and respiratory disorders)
Age (older drivers)
Chapter 8 (miscellaneous conditions) Atrial defibrillator
AIDS and HIV infection
Chapter 8 (miscellaneous conditions) Attention deficit hyperactivity disorder
(ADHD)
Alcohol misuse/dependence Chapter 4 (psychiatric disorders)
Chapter 5 (drug or alcohol misuse
or dependency) Autism
Alcohol seizures/disorders
Chapter 5 (drug or alcohol misuse Autistic spectrum disorder
or dependency) Chapter 4 (psychiatric disorders)
Alzheimer’s disease
B
Behavioural disorders
Amaurosis fugax
Benign infratentorial tumour
Ambulance drivers
General information
Benign supratentorial tumour
Aneurysm (aortic)
Bicuspid aortopathy)
Angina (stable or unstable)
Bipolar illness
Angiography (coronary)
Blepharospasm
Anxiety
Chapter 6 (visual disorders)
Brain tumours
Aortic dissection (chronic)
Contents
Index
132
Index
C Coronary artery bypass graft (CABG)

Cancers
Chapter 8 (miscellaneous conditions) Coronary artery disease
Carcinoma of lung
Chapter 7 (renal and respiratory disorders) Cough syncope
Cardiac resynchronisation therapy
Chapter 2 (cardiovascular disorders) Craniectomy and subsequent
cranioplasty
Cardiomyopathy (hypertrophic)
Cardiomyopathy (dilated)
Chapter 2 (cardiovascular disorders) D
Carotid artery stenosis Defibrillator – cardioverter
Cataract Deafness
Chapter 6 (visual disorders) Chapter 8 (miscellaneous conditions)
Catheter ablation Dementia
Chapter 2 (cardiovascular disorders) Chapter 4 (psychiatric disorders)
Cavernous malformation Depression
Chapter 1 (neurological disorders) Chapter 4 (psychiatric disorders)
Chiari malformation Developmental disorders
Chapter 1 (neurological disorders) Chapter 4 (psychiatric disorders)
Chronic neurological disorders Diabetes
Chapter 1 (neurological disorders) Chapter 3 (diabetes mellitus)
Chronic renal failure Diabetes leaflet (INF188/2)
Chapter 7 (renal and respiratory disorders) Appendix D
Chronic subdural Diplopia
Chronic obstructive
Disabled drivers
pulmonary disease (COPD)
Appendix F (disabilities and vehicle adaptations)
Disabled driving assessment centres
Colour blindness
Appendix G (Mobility Centres and Driving
Assessment Centres)
Colloid cysts
Dizziness
Congenital complete heart block
Chapter 2 (cardiovascular disorders) Driving after surgery
General information
Congenital heart disease
Chapter 2 (cardiovascular disorders) Drug misuse/dependency
Chapter 5 (drug or alcohol misuse or dependency)
Continuous ambulatory
peritoneal dialysis (CAPD) Dural AV fistula
Chapter 7 (renal and respiratory disorders) Chapter 1 (neurological disorders)
Coronary angiography DVLA contact details

Chapter 2 (cardiovascular disorders) General information
Contents
Index
133
Index
E Head injury – traumatic

ECG abnormality
Chapter 2 (cardiovascular disorders) Heart failure
Eclamptic seizures
Heart/heart lung transplant
Elective percutaneous coronary
Heart valve disease
intervention (PCI)
Hemianopia
Encephalitic illness Chapter 6 (visual disorders)
High risk offender scheme
Epilepsy
Chapter 5 (drug or alcohol misuse
or dependency)
Epilepsy regulations
HIV infection
Chapter 8 (miscellaneous conditions)
Exercise tolerance test (ETT) and
hypertrophic cardiomyopathy Huntington’s disease
Chapter 2 (cardiovascular disorders) Chapter 1 (neurological disorders)
Appendix F (disabled drivers and vehicle
Excessive sleepiness adaptations)
Hydrocephalus
Exercise testing
Hypertension
Extraventricular drain
Hypertrophic cardimyopathy
F
Hypoglycaemia
Field of vision requirements Chapter 3 (diabetes mellitus)
Hypomania/mania
Foramen magnum decompression Chapter 4 (psychiatric disorders)
I
G
Impairment due to medication
Glaucoma General information
Impairment of cognitive function
Gliomas
Impairment secondary to
multiple medical conditions
H General information
Haematoma – intracerebral Implantable cardioverter defibrillator (ICD)
Healthcare vehicle drivers Implanted electrodes
General information Chapter 1 (neurological disorders)
Contents
Index
134
Index
Infratentorial AVMs Multiple sclerosis

Intracerebral abscess Muscle disorders
Intracranial pressure monitor Myocardial infarction
Intraventricular shunt
Chapter 1 (neurological disorders) N
Isolated seizure Neuroendoscopic procedures
Night blindness
L Chapter 6 (visual disorders)
Learning disability Non-epileptic seizure attacks
Chapter 4 (psychiatric disorders) Chapter 1 (neurological disorders)
Left bundle branch block Nystagmus
Chapter 2 (cardiovascular disorders) Chapter 6 (visual disorders)
Left ventricular assist devices
Chapter 2 (cardiovascular disorders) O
Loss of consciousness/loss of Obstructive sleep apnoea syndrome
or altered awareness Chapter 8 (miscellaneous conditions)
Organic brain syndrome
M
Malignant tumours P
Pacemaker implant
Marfan syndrome Chapter 2 (cardiovascular disorders)
Parkinson’s disease
Meningioma Chapter 1 (neurological disorders)
Peripheral arterial disease (PAD)
Meningitis with coronary artery disease
Mild cognitive impairment (MCI) Peripheral neuropathy
Chapter 4 (psychiatric disorders) Chapter 3 (diabetes mellitus)
Monocular vision Personality disorder
Chapter 6 (visual disorders) Chapter 4 (psychiatric disorders)
Motor cortex stimulator Pituitary tumour
Motor neurone disease Police vehicle drivers
Chapter 1 (neurological disorders) and General information
Appendix F (disabled drivers and vehicle
adaptations) Pre-excitation
Contents
Index
135
Index
Primary/central hypersomnias Supratentorial AVMs

Provoked seizures Syncopal attacks
Chapter 1 (neurological disorders) Chapter 2 (cardiovascular disorders) and
Psychiatric notes
Psychosis T
Chapter 4 (psychiatric disorders) Taxi licensing
General information
R TIA
Reflex vasovagal syncope Chapter 1 (neurological disorders)
Chapter 1 (neurological disorders) Transient global amnesia
Renal disorders Chapter 1 (neurological disorders)
Chapter 7 (renal and respiratory disorders) Transient arrhythmias
Respiratory disorders Chapter 2 (cardiovascular disorders)
Chapter 7 (renal and respiratory disorders) Transphenoidal surgery
S Traumatic brain injury

Schizophrenia
Seizures U
Chapter 5 (drug or alcohol misuse V
or dependency)
Valve heart disease
Serious neurological disorders Chapter 2 (cardiovascular disorders)
Ventricular cardiomyopathy
Spontaneous acute subdural Chapter 2 (cardiovascular disorders)
haematoma
Chapter 1 (neurological disorders) Visual acuity
Strokes/TIAs
Chapter 1 (neurological disorders) Visual field defects
Subarachnoid haemorrhage
Chapter 1 (neurological disorders) Visual field requirements
Subdural empyema
Substance misuse
W
Chapter 1 (neurological disorders) Withdrawal of epileptic medication
Chapter 5 (drug or alcohol misuse Chapter 1 (neurological disorders)
or dependency)
Contents
Index
136
Assessing fitness to drive
– a guide for medical professionals
DVLA
Longview Road
Morriston
Swansea
SA6 7JL
www.gov.uk/dvla/fitnesstodrive
© Crown copyright – DVLA 1993-2021

This document may be cited in part or in whole for the specific guidance of doctors and patients. However, the
document must not be reproduced in part or in whole for commercial purposes.
This guidance is published by the Department for Transport. It describes the law relating to medical aspects of
driver licensing. In particular, it advises members of the medical profession on the medical standards that need
to be met by individuals to hold licences to drive various categories of vehicle. The Department for Transport has
prepared this document on the advice of the Secretary of State’s Honorary Advisory Panels of medical specialists.
This document provides the basis on which members of the medical profession advise individuals on whether
any particular condition could affect their driving entitlement. It is the responsibility of the individual to report the
condition to the DVLA in Swansea.

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Assessing fitness to drive

– a guide for medical professionals

■ insight and understanding

■ good reaction time

■ planning and organisation

■ muscle power and control

The guidelines and their development

■ alcohol or substance misuse and dependence

Age limits for licensing

Police, fire, ambulance and health service driver licensing

Sudden disabling events

Disclosing information with consent

Disclosing information without consent

How DVLA responds to notification and applies the

Outcome of medical enquiries

Seat belt use and exemption

■ visual conditions and disorders in Chapter 6

■ excessive sleepiness in Chapter 8

The following definitions apply:

Transient loss of consciousness (‘blackouts’)

Syncope See pages 23-26 of this chapter

Seizure/epilepsy See pages 18-20 of this chapter

Hypoglycaemia See page 72 for Chapter 3 (diabetes mellitus)

See page 90 for Chapter 5

Undetermined See pages 23-26 of this chapter, ‘syncope’

See page 116, ‘medication effects’

In relation to road safety, however, the 2 most important features are:

■ posture – do the episodes of TLoC occur while sitting?

Typical vasovagal syncope

Syncope with avoidable trigger or otherwise reversible cause

Unexplained syncope, including syncope without reliable prodrome

Cardiovascular, excluding typical syncope

■ amnesia longer than 5 minutes

■ post ictal confusion

■ headache post attack

Transient loss of consciousness – recurring episodes

Recurrent typical vasovagal syncope with identifiable consistent prodrome

Recurrent syncope with avoidable trigger or otherwise reversible cause

Further investigations such as 48-hour ambulatory ECG, echocardiography and

Recurrent unexplained syncope, including syncope without reliable prodrome

Recurrent cardiovascular but excluding typical vasovagal syncope

Recurrent blackout with seizure markers

Chronic neurological disorders

Must notify DVLA. Must notify DVLA.

Must notify DVLA. Must notify DVLA.

Must not drive on presentation Must not drive on presentation

Single transient Must not drive for 1 month but

Multiple transient Must not drive and must

Must not drive and must notify DVLA.

Carotid artery stenosis

Acute encephalitic illness and meningitis

May drive provided epilepsy, any Driving is not barred by a single

Asymptomatic May drive and need not Must notify DVLA.

Benign brain tumours

Benign supratentorial non-parenchymal tumour (WHO grade I meningioma, for example)

WHO grade II meningiomas treated with craniotomy and/or radiosurgery

Asymptomatic incidental meningiomas not needing treatment

Malignant brain tumours

■ no further primary treatment (with