This information is aimed at healthcare professionals involved in assessing fitness to drive after a stroke or TIA.
Summary of the UK guidelines
The DVLA deals with all aspects of driver licensing when there are medical conditions that impact, or potentially impact, on safe control of a vehicle. There are two types of licence holders with age limits applicable to both:
- Group 1 – cars and motorcycles
- Group 2 – large lorries (category C) and buses (category D)
There are also standards for police, fire, ambulance and health service drivers, with licences for taxis the responsibility of local authorities.
The DVLA provides specific advice for assessment of driving after a stroke or TIA including amaurosis fugax. In summary, group 1 licence holders who have a stroke must not drive for a month and can only resume if there has been a satisfactory clinical recovery, especially visual field defects and cognitive defects and impaired limb function. The DVLA only has to be notified if recovery is not deemed satisfactory.
People who have a single TIA must not drive for a month and don’t need to notify the DVLA. Those who have multiple TIAs must not drive, have to notify the DVLA and if they occurred over a short period (a time frame is not specified) can only resume driving after 3 months if there have been no further TIAs.
The criteria for group 2 drivers are more onerous for both stroke and TIA, with the licence refused/revoked for a year.
Absolute bars to driving include epileptic seizure (excluding seizure within 24 hours of stroke onset), significant visual field defects, reduced visual acuity or double vision). If any of these are evident, the patient needs to inform the DVLA and not drive.
Applicants and licence holders have a legal duty to:
- notify the DVLA of any injury or illness that would have a likely impact on safe driving ability (except some short-term conditions)
- respond fully and accurately to any requests for information from either the DVLA or healthcare professionals
- comply with the requirements of the issued licence, including any periodic medical reviews indicated by the DVLA
DVLA guidance states that doctors and other healthcare professionals should:
- advise the individual on the impact of their medical condition for safe driving ability
- advise the individual on their legal requirement to notify the DVLA of any relevant condition
- treat, manage and monitor the individual’s condition with ongoing consideration of their fitness to drive
- notify the DVLA when fitness to drive requires notification but an individual cannot or will not notify the DVLA themselves
The last obligation may pose a challenge to issues of consent and the relationship between patient and healthcare professional and the General Medical Council provide their own guidance.
The RCP National Clinical Guideline for Stroke (2016) recommends:
- People who have had an acute stroke or TIA should be asked about driving before they leave the hospital or specialist outpatient clinic
- People with persisting cognitive, language or motor disability after stroke who wish to return to driving should be referred for on-road screening and evaluation.
- People with stroke who wish to drive should:
- be advised of the exclusion period from driving and their responsibility to notify the DVLA
- If they have any persisting disability which may affect their eligibility;
- be asked about or examined for any absolute bars to driving e.g. epileptic seizure (excluding seizure within 24 hours of stroke onset), significant visual field defects, reduced visual acuity or double vision
- be offered an assessment of the impairments that may affect their eligibility, including their cognitive, visual and physical abilities
- receive a written record of the findings and conclusions, copied to their general practitioner
- People who wish to drive after stroke should be informed about eligibility for disabled concessions
Best practice pathway
The following pathway is based on the relevant guidelines and examples of local best practice. There is some evidence for assessments that most accurately predict driving performance (which should include examination of cognition, visual or physical impairments), however, many have limitations such as being unsuitable for aphasia and as a result there is significant variation in local practice.
Resources including websites, leaflets plus example forms and letters are presented at the bottom of the page.
- Allow time for adequate recovery. Assessments should be undertaken when driving is an achievable goal. For example, if a patient has a significant visual field loss, returning to driving at that point is not appropriate regardless of performance on cognitive tests/physical abilities
- If assessments highlight concerns, consider re-assessment of abilities at a later date before referring to the North West Driving Assessment Service to maximise the chances of being able to drive safely once recovery has reached a plateau
- Consider the timing of a review of ability to drive. Depending on recovery, this may be as early as 3 weeks post stroke and this will allow enough time to make and send recommendations to the patient and their GP
- People may need to inform their insurance company after a stroke or TIA
RCP National Clinical Guideline for Stroke 2016 (section 4.1.3 page 55)