Dr Kathryn Leask
Dr Kathryn Leask discusses what to do if a patient requests a fitness-to-drive letter.
Must I sign him as fit to drive?
Q I am a private GP and have a patient in their 70s who has asked me to provide them with a letter to confirm they are fit to drive, pending renewal of their driving licence by the DVLA.
They have referred to section 88 of the 1988 Road Traffic Act. As such, the patient feels that this means they can have a letter from their doctor to allow them to continue to drive.
Is this the case? Please could you advise further?
A Your patient will be aware of the guidance issued by the DVLA which may allow them to continue driving even though they do not hold a current driving licence.
This can apply when a new licence has been applied for – for example, once they are over the age of 70 – and the application is being processed. The guidance states that ‘Your doctor must have told you that you are fit to drive’.
When considering writing a letter for a patient with regards to their fitness to drive, you must act within the limits of your competency and expertise, as set out in the GMC’s Good Medical Practice guidance (paragraph 14), and any form that you complete or sign must be accurate and contain all relevant information (paragraph 71).
In general terms, it is for the DVLA medical assessors to assess a person’s fitness to drive, and for the patient’s doctor to provide relevant information for the assessors to do so.
However, due to the delays that have occurred in processing licences, applicants have been requesting letters from their doctor to confirm they are fit to drive.
Occasionally, you may feel there are circumstances in which you are able to confirm that you have no reason to believe, based on the information available to you, that a patient may not be fit to drive, as you are not aware of any medical condition that requires notification to the DVLA.
The DVLA document ‘Assessing fitness to drive – a guide for medical professionals’ is a useful resource for this purpose.
If appropriate, you can confirm that there is nothing in the medical records that would exclude the patient from driving or that would require notifying the DVLA.
But it is recommended that you state that the patient has not, however, been examined for the purposes of assessing their fitness to drive.
Additionally, consider whether you have a complete picture of their medical history, particularly if the patient is only seeing you for a specific medical problem and also has an NHS GP, as well as the reason why they are having to re-apply for their licence.
Patients also need to be aware that undeclared conditions could affect their ability to drive (listed in the above document) and they would need to seek further assessment.
Finally, think about whether you are the best person to write such a letter, based on the information you have about the patient’s health.
This would allow you to state, with confidence, that they do not have a condition that could affect their ability to drive.
Dr Kathryn Leask is a medico-legal adviser at the Medical Defence Union
When mum wants dad excluded
Dr Sally Old
A consultant’s concerns about potential problems disclosing records to a parent with parental responsibility are tackled by Dr Sally Old.
Do I accede to mum’s request?
Q I recently saw a young child who had attended my practice along with their mother. The child is asthmatic, and the mother wanted to discuss their regular medication.
However, the parents are divorced and the mother does not want the father to have access to the child’s medical records, as he has just been released from prison.
She is concerned that he will use the records to find out where she lives and she feels vulnerable to physical attack.
I’m not sure what I should do in this situation. Can you advise please?
A In most instances, anyone with parental responsibility for a child has a right to seek access to that child’s medical records.
Parental responsibility is defined in The Children Act 1989 as ‘all the rights, duties, powers, responsibilities and authority which by law a parent of a child has in relation to the child and [their] property’.
Birth mothers automatically have parental responsibility, as do married fathers.
Parents do not lose parental responsibility if they divorce, but responsibility can be restricted by a court.
When one parent asks the practice to disclose information about the child, there is no obligation to seek consent from the other parent or to tell the other parent that you have received the request.
Nevertheless, it may be wise to make sure the other parent is aware of the request, so that you can take into account any objection they may make and the reasons for it.
The GMC states that a doctor may allow someone with parental responsibility to access a child’s medical records if the child or young person consents or if they lack capacity and it doesn’t go against the child’s best interests.
However, the guidance also says: ‘If the records contain information given by the child or young person in confidence, you should not normally disclose the information without their consent.’
It may also be justifiable to disclose confidential information about the child to a third party who does not hold parental responsibility, providing this is clearly in the child’s best interests.
As previously mentioned, a father with parental responsibility has a right to request disclosure of his child’s records.
But as information should be withheld if disclosure would be contrary to the best interests of the child or if disclosure could lead to serious harm or be unreasonable to a third party, it would be entirely reasonable in this situation to remove the registered address from any copy records disclosed in this situation.
Dr Sally Old is a medico-legal adviser at the Medical Defence Union