The DVLA and the DVA have legal responsibility for deciding if a person is medically unfit to drive.

The patient is legally responsible for informing the DVLA or DVA, if they do not meet the vision standard for driving. Information on how they can do this is in the Useful information section below. However, if you think the patient may pose a very real risk of danger to the public, but you are not sure whether you should act, ask yourself: 

1. what might the outcome be in the short or longer term if I do not raise my concern? 
2. how could I justify not raising the concern?

If you decide that the patient is unfit to drive, you should:

1. tell the patient that they are unfit to drive and give the reasons. You may wish to discuss your concerns with a relative or carer, if the patient consents to this
2. tell the patient that they have a legal duty to inform the DVLA or DVA about their condition and that you may be obliged to tell the DVLA or DVA if the patient continues to drive when they are unfit to do so
3. put your advice in writing to the patient
4. record your advice and keep a copy of any correspondence to the patient on the patient record.

If the patient does not accept that they are unfit to drive, you may suggest that they seek a second opinion. You should advise the patient not to drive in the meantime.

Sometimes, the actions in the section, If you think a patient is unfit to drive, might not achieve their aim, or would take too long to do so. You have a duty of confidentiality to the patient, but this is not absolute and can be broken if it is in the public interest to do so. Guidance from the Department of Health includes the example of reporting a driver who rejects medical advice not to drive as one where the public interest can be a defence to breaching patient confidentiality.¹¹²

If you conclude that the public interest outweighs the duty of confidentiality, you should tell the patient you intend to notify the DVLA or DVA. If the patient objects to your decision, you should listen to, and record their reasons for doing so.

If you decide to notify the DVLA or DVA you should:

1. notify the appropriate authority (DVLA or DVA) in writing, and, if appropriate, provide evidence of clinical findings (see useful information below)
2. notify the patient
3. make a note on the patient record
4. consider whether to notify other healthcare professionals, such as the patient’s GP.

If you are considering informing the DVLA or DVA that the patient may not be fit to drive, you may wish to contact your professional or representative body for advice.