DVLA's guide for medical professionals to help them with enquiries from the public about driving with various conditions.

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Updated: • Heart valve surgery (New) • Hypertrophic Cardiomyopathy (Amended)

How to use this guide

This guide is for medical professionals to help with any enquiries from the general public about driving with various conditions. Only applies to Great Britain and Northern Ireland.

Use the A to Z navigation on the left to find specific conditions and the medical standards associated with them.

This guide is also available in the basic PDF booklet.

General advice to give to drivers

It is advised that the applicant or licence holder must notify DVLA, unless stated otherwise in the text relating to specific conditions. In some cases, a combination of multiple medical conditions, each insufficient in itself to disqualify from driving, may produce an annual risk of incapacitation unacceptable for either a Group 1 or a Group 2 licence, or render a person a likely source of danger.

When such a combination of risk factors is felt to be present, the patient should be advised not to drive. Health professionals can get additional clarification from the DVLA.

Advice for the general public

Use the ‘quick answer’ guide to search for specific health conditions and driving ‘quick answer’ guide.

G

There are currently no conditions under this section.

H

This section covers conditions from ‘Haematoma - Intracerebral’ to ‘Hypomania/Mania’.

Haematoma - Intracerebral

See Arteriovenous malformation - supratentorial.

Head injury (traumatic)

Group 1 entitlement ODL – car, motorcycle

Usually requires 6-12 months off driving depending on features such as seizures, PTA, dural tear, haematoma and contusions. There will need to have been a satisfactory clinical recovery and in particular no visual field defect, or cognitive impairment likely to affect safe driving.
See also Disabled drivers appendix and Appendix 2 - Forum of Mobility Centres.

Group 2 entitlement vocational – lorries, buses

Refusal or revocation. May be able to return to driving when the risk of seizure has fallen to no greater than two per cent per annum, and with no debarring residual impairment likely to affect safe driving.

Heart failure

Group 1 entitlement ODL – car, motorcycle

Driving may continue provided there are no symptoms that may distract the driver’s attention - DVLA need not be notified.

Group 2 entitlement vocational – lorries, buses

NB: A Left Ventricular Ejection Fraction of < 0.4 is considered a bar to Group 2 Entitlement.

Disqualifies from driving if symptomatic.

Re/licensing may be permitted provided:

  • the LV ejection fraction is = to or > 0.4
  • there is no other disqualifying condition

Exercise or other functional testing may be required depending on the likely cause for the heart failure.

Heart or heart/lung transplant

Group 1 entitlement ODL – car, motorcycle

Driving may continue provided the driver is not suffering from a disqualifying condition - DVLA need not be notified.

Group 2 entitlement vocational – lorries, buses

NB: A Left Ventricular Ejection Fraction of < 0.4 is considered a bar to Group 2 Entitlement.

Disqualifies from driving if symptomatic.

Re/licensing may be permitted provided:

  • the exercise or other functional test requirements can be met
  • the LV ejection fraction is = to or > 0.4
  • there is no other disqualifying condition

Heart valve disease

(To include surgery, ie replacement and/or repair)

See Aortic Stenosis

Group 1 entitlement ODL – car, motorcycle

Driving may continue provided no other disqualifying condition - DVLA need not be notified.

Group 2 entitlement vocational – lorries, buses

NB: A Left Ventricular Ejection Fraction of < 0.4 is considered a bar to Group 2 Entitlement.

Disqualifies from driving:

  • whilst symptomatic
  • for 12 months after cerebral embolism following which specialist assessment is required to determine licensing fitness

Re/licensing may be permitted provided that there is no other disqualifying condition.

Heart valve surgery

(including Transcatheter Aortic Valve Implantation)

Group 1 entitlement ODL – car, motorcycle

Driving must cease for at least 4/52.

Driving may recommence thereafter provided there is no other disqualifying condition. DVLA need not be notified.

Group 2 entitlement vocational – lorries, buses

Disqualifies from driving for at least 3/12.

Relicensing may be permitted thereafter provided:

  • there is no evidence of significant impairment of left ventricular function i.e. LVEF is = to or > 40%
  • there is no ongoing symptom and any other disqualifying condition

Hemianopia

See Visual field defects.

Heroin

NB: Multiple substance misuse and/or dependence – including misuse with alcohol – is incompatible with licensing fitness.

Reference to ICD10 F10.1-F10.7 inclusive is relevant.

Group 1 entitlement ODL – car, motorcycle

Persistent use of, or dependence on these substances, confirmed by medical enquiry, will lead to licence refusal or revocation until a minimum one year period free of such use has been attained. Independent medical assessment and urine screen arranged by DVLA, may be required. In addition favourable consultant or specialist report may be required on reapplication.

Group 2 entitlement vocational – lorries, buses

Persistent use of, or dependence on these substances, will require revocation or refusal of a vocational licence until a minimum three year period free of such use has been attained. Independent medical assessment and urine screen arranged by DVLA, will normally be required. In addition favourable consultant or specialist report will be required before relicensing.

High risk offender scheme

See Drug and alcohol misuse and dependence chapter appendix.

HIV positive

Group 1 entitlement ODL – car, motorcycle

Need not notify DVLA.

Group 2 entitlement vocational – lorries, buses

Need not notify DVLA.

Huntington’s disease

See Chronic neurological disorders.

Hydrocephalus

Group 1 entitlement ODL – car, motorcycle

If uncomplicated, Till 70 licence retained.

Group 2 entitlement vocational – lorries, buses

Can be issued with a licence if uncomplicated and no associated neurological problems.

Hypertension

Group 1 entitlement ODL – car, motorcycle

Driving may continue unless treatment causes unacceptable side effects - DVLA need not be notified.

Group 2 entitlement vocational – lorries, buses

NB: A Left Ventricular Ejection Fraction of < 0.4 is considered a bar to Group 2 Entitlement.

Disqualifies from driving if resting BP consistently 180 mm Hg systolic or more and/or 100 mm Hg diastolic or more.

Re/licensing may be permitted when controlled provided that treatment does not cause side effects which may interfere with driving.

Hypertrophic Cardiomyopathy (HCM)

See also the following pages:

Arrhythmia
Pacemaker
ICD - implanted for ventricular arrhythmia associated with incapacity
ICD - implanted for sustained ventricular arrhythmia which did not cause incapacity

Group 1 entitlement ODL – car, motorcycle

Driving may continue provided no other disqualifying condition - DVLA need not be notified.

Group 2 entitlement vocational – lorries, buses

NB: A Left Ventricular Ejection Fraction of < 0.4 is considered a bar to Group 2 Entitlement.

Disqualifies from driving if symptomatic.

Re/Licensing may only be permitted when at least three of the following criteria are met:

  • there is no family history in a first degree relative of sudden premature death from presumed HCM
  • the cardiologist can confirm that the HCM is not anatomically severe. The maximum wall thickness does not exceed 3cm
  • there is no serious abnormality of heart rhythm demonstrated; eg Non-Sustained Ventricular Tachycardia (NSVT)
  • there is at least a 25mm Hg increase in systolic blood pressure during exercise testing - (exercise testing to be repeated every three years)

Hypoglycaemia

For information in relation to hypoglycaemia please refer to the relevant Diabetes related condition in the Medical A-Z or select the link below:

Hypoglycaemia from any cause other than the treatment of diabetes

Hypoglycaemia from any cause other than the treatment of diabetes

Group 1 entitlement ODL – car, motorcycle

If suffering episodes of severe hypoglycaemia should cease driving while liable to these episodes. Examples would include after bariatric surgery or in association with eating disorders.

Group 2 entitlement vocational – lorries, buses

If suffering episodes of severe hypoglycaemia should cease driving while liable to these episodes. Example would include after bariatric surgery or in association with eating disorders.

Hypomania/Mania

NB: For cases, which also involve persistent misuse of or dependence on alcohol/drugs, please refer to the appropriate drug and alcohol misuse and dependence related condition in the Medical A-Z. Where psychiatric illness has been associated with substance misuse, continuing misuse is not acceptable for licensing.

Group 1 entitlement ODL – car, motorcycle

Driving must cease during the acute illness. Following an isolated episode, re-licensing can be reconsidered when all the following conditions can be satisfied:

  • has remained well and stable for at least three months
  • is compliant with treatment
  • has regained insight
  • is free from adverse effects of medication which would impair driving
  • subject to a favourable specialist report

Repeated changes of mood: Hypomania or mania are particularly dangerous to driving when there are repeated changes of mood. Therefore, when there have been 4 or more episodes of mood swing within the previous 12 months, at least 6 months stability will be required under condition (a), in addition to satisfying conditions (b) to (e).

Group 2 entitlement vocational – lorries, buses

Driving must cease pending the outcome of medical enquiry. It is normally a requirement that the person should be well and stable for 3 years (ie to have experienced a good level of functional recovery with insight into their illness and to be fully adherent to the agreed treatment plan, including engagement with the medical services) before driving can be resumed.

In line with good practice, attempts should be made to achieve the minimum effective dose of psychotropic medication; tolerability should be optimal and not associated with any deficits (eg in alertness, concentration and motor performance) that might impair driving ability. Where in patients with established illness the history suggests a likelihood of relapse, the risk should be appraised as low (either in the treated or untreated state).

DVLA will normally require a consultant report that specifically addresses the relevant issues above before the licence can be considered.

I

This section covers conditions from ‘Impaired awareness of Hypoglycaemia’ to ‘Intraventricular shunt or extraventricular drain’.

Impaired awareness of Hypoglycaemia

Group 1 entitlement ODL – car, motorcycle

If confirmed, driving must stop. Driving may resume provided reports show awareness of hypoglycaemia has been regained, confirmed by consultant/GP report.

Group 2 entitlement vocational – lorries, buses

See Insulin treated. Refusal or revocation.

Impairment due to medication

It is an offence to drive or attempt to drive whilst unfit through drugs; the law does not distinguish between illegal drugs and prescribed medication. Some prescription drugs and over the counter medicines can affect the skills needed to drive safely because they may cause drowsiness, impaired judgement or other adverse effects. Health professionals prescribing or dispensing medication should consider the risk associated with that medicine, or combination of medicines, and driving and take the opportunity to appropriately advise their patients.

Impairment of cognitive function

See Disabled drivers appendix.

Impairment secondary to multiple medical conditions

In some cases, a combination of multiple medical conditions, each insufficient in itself to disqualify from driving, may produce an annual risk of incapacitation unacceptable for either a Group 1 or a Group 2 licence, or render a person a likely source of danger.

When such a combination of risk factors is felt to be present, the patient should be advised not to drive. The health professional may seek clarification from the DVLA.

Implantable cardioverter defibrillator (ICD) - implanted for ventricular arrhythmia associated with incapacity

Implanted for ventricular arrhythmia associated with incapacity.

Group 1 entitlement ODL – car, motorcycle

Patients with ICDs implanted for sustained ventricular arrhythmias should not drive for:

  1. A period of 6/12 after the first implant.
  2. A further 6/12 after any shock therapy and/or symptomatic antitachycardia pacing (see 3a below).
  3. A period of 2 years if: 3(a). any therapy following device implantation has been accompanied by incapacity (whether caused by the device or arrhythmia), except as in 3b and 3c 3(b). therapy was delivered due to an inappropriate cause, ie atrial fibrillation or programming issues, then driving may resume 1/12 after this has been completely controlled to the satisfaction of the cardiologist

(DVLA need not be notified regarding any of the above).

3(c). the incapacitating shock was appropriate (ie for sustained VT or VF) and steps have been taken to prevent recurrence, (e.g.introduction of anti-arrhythmic drugs or ablation procedure) driving may resume after 6/12 in the absence of further symptomatic therapy

For 2 and 3a/3c, if the patient has been re-licensed prior to the event, DVLA should be notified.

  1. A period of 1/12 off driving must occur following any revision of the electrodes or alteration of anti-arrhythmic drug treatment.

  2. A period of 1/52 off driving is required after a defibrillator box change.

Resumption of driving requires that:

  1. The device is subject to regular review with interrogation.
  2. There is no other disqualifying condition.

Group 2 entitlement vocational – lorries, buses

NB: A Left Ventricular Ejection Fraction of < 0.4 is considered a bar to Group 2 Entitlement.

Permanently bars.

Implantable cardioverter defibrillator (ICD) implanted for sustained ventricular arrhythmia which did not cause incapacity

Group 1 entitlement ODL – car, motorcycle

If the patient presents with a non-disqualifying cardiac event, ie haemodynamically stable non-incapacitating sustained ventricular tachycardia, the patient can drive 1/12 after ICD implantation providing all of the following conditions are met:

  • LVEF > than 35 per cent
  • no fast VT induced on electrophysiological study (RR< 250 msec)
  • any induced VT could be pace-terminated by the ICD twice, without acceleration, during the post implantation study

DVLA need not be notified.

Should the ICD subsequently deliver ATP and/or shock therapy (except during normal clinical testing) then the licensing criteria on the previous page applies and DVLA should be notified.

Group 2 entitlement vocational – lorries, buses

NB: A Left Ventricular Ejection Fraction of < 0.4 is considered a bar to Group 2 Entitlement.

Permanently bars.

Implanted electrodes

Group 1 entitlement ODL – car, motorcycle

Deep brain stimulation for movement disorder or pain If no complications from surgery and seizure free, can drive when there is no debarring residual impairment likely to affect safe driving.

Implanted motor cortex stimulator for pain relief If aetiology of pain is non-cerebral eg trigeminal neuralgia, 6 months off. If the aetiology is cerebral eg stroke, 12 month off. Can then drive when there is no debarring residual impairment likely to affect safe driving.

Group 2 entitlement vocational – lorries, buses

Deep brain stimulation for movement disorder or pain: if no complications from surgery, seizure free and underlying condition non-progressive, fitness to drive can when there is no debarring residual impairment likely to affect safe driving.

Implanted motor cortex stimulator for pain relief: refusal or revocation.

Incidental asymptomatic low grade gliomas on imaging

Group 1 entitlement ODL – car, motorcycle

Individual assessment. Initially regular licence review (usually annually).

Group 2 entitlement vocational – lorries, buses

Revoke/refuse.

May be considered after 1 year if there is favourable annual clinical assessment and the subsequent specialist opinion is that the lesion is not actually a glioma.

Infratentorial AVMs

See Arteriovenous malformation - infratentorial.

Intracerebral abscess/Subdural empyema

Group 1 entitlement ODL – car, motorcycle

One year off driving.

Group 2 entitlement vocational – lorries, buses

Refusal or revocation. Very high prospective risk of seizure(s). May consider licensing if 10 years seizure-free from treatment.

Intracranial pressure-monitoring device

Inserted by Burr hole surgery.

Group 1 entitlement ODL – car, motorcycle

The prospective risk from the underlying condition must be considered.

Group 2 entitlement vocational – lorries, buses

The prospective risk from the underlying condition must be considered.

Intraventricular shunt or extraventricular drain

Insertion or revision of upper end of ventricular shunt or extra-ventricular drain.

Group 1 entitlement ODL – car, motorcycle

Six months off. Can then be re-licensed when there is no debarring residual impairment likely to affect safe driving.

Group 2 entitlement vocational – lorries, buses

Minimum 6 months off and then licensing shall be dependent upon the individual assessment of the underlying condition.


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