Undercover doctors?

The General Medical Council (GMC) has issued draft guidance on confidentiality. It emphasises a doctor's duty to disclose information to the DVLA where a patient fails to act.

The guidance is part of a public consultation on giving doctors clearer advice about balancing their legal and ethical duties of confidentiality, with their wider public protection responsibilities. The consultation is running until 10 February 2016, and you can give your views via the GMC's website.

The issue of 'older drivers' is always a hotly debated topic. Many point out that older drivers are safer and more reliable than their younger counterparts. They argue that removing licences will result in lost independence, particularly because of poor public transport services. A recent comment piece in The Telegraph1 newspaper noted:

'The risk in the GMC proposals is that some patients will think twice about being frank with their doctor, or seeing a doctor at all, if they believe it could cost them their licence.'

Niall Dickson, chief executive of the GMC, acknowledges that this is difficult territory: '...most patients will do the sensible thing, but the truth is that a few will not and may not have the insight to realise that they are a risk to others behind the wheel of a car.'

I am of the view that anything offering clarity to doctors about what they can and cannot share is helpful. And this guidance isn't placing an absolute duty on medical professionals to report people.

Rather, it reassures doctors that if a patient does pose a risk of serious harm to the public by continuing to drive when they are not fit to do so, they should contact the DVLA, even if they do not have the patient's consent to do so.

This is a step to take as a last resort, only if attempts to work together have failed. It applies to anyone with a medical condition that affects their ability to drive, not just to older drivers.

The DVLA's 'current medical standards of fitness to drive' for medical practitioners states:

'Age is no bar to the holding of a licence. DVLA requires confirmation at the age of 70 that no medical disability is present. Thereafter, a three year licence is issued subject to satisfactory completion of medical questions on the application form. However, as ageing progresses, a driver or his/her relative(s) may be aware that the combination of progressive loss of memory, impairment in concentration and reaction time with possible loss of confidence, suggest consideration be given to cease driving. Physical frailty is not per se a bar to the holding of a licence.'

The DVLA must know if you have a driving licence and:

• You develop a notifiable medical condition or disability (a 'notifiable condition' is anything that affects your ability to drive in a safe way);
  or

• A condition or disability has got worse since you got your licence.

The impact of dementia on driving ability is always difficult to assess. Those who have poor short-term memory, disorientation, lack of insight and judgement are 'almost certainly' not fit to drive2.

Once notified, the DVLA will assess the medical condition or disability. They will decide whether adaptations to the vehicle are necessary, or whether a limited licence is appropriate. The DVLA can also decide that the licence must be surrendered.

If a licence is being given up voluntarily, then the form that needs to be completed is available on the DVLA website.

I don't agree with the interpretation that GPs are becoming 'agents of the DVLA' as a result of the guidance. It worries me that this sort of development gets such negative coverage in the press, especially as the consequences of driving when medically unfit are often tragic and fatal. n

References

1. The Telegraph article: https://bit.ly/1Jfqgjx

2. The DVLA's medical guidelines for professionals: https://bit.ly/1UgfXfL

Sofia Tayton is a partner and head of care and capacity at Lodders Solicitors

She writes the regular in-practice article on care and capacity for Private Client Adviser