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Should GPs check elderly patients’ ability to drive?

Dr Justine Hall argues the approach would help to save lives, provided GPs are resourced to do it, but Dr Matt Piccaver counters that GPs are not best placed to carry out such a complex assessment

Dr Justine Hall

YES 

This will help save lives if properly resourced

We’ve all done it. Watched an elderly relative or neighbour get into their car, rev the engine and disappear off up the road. Few of us could say that it has never crossed our mind that this driver posed a risk to the public onthe roads.

When I was a registrar, a gentleman ploughed his car into the lamp post outside the surgery, having mounted the pavement several hundred feet earlier, narrowly missing a mum and baby in pram.

This is something I have never forgotten. And we have seen all too often cases in the press of elderly drivers crashing into buildings or pedestrians, with devastating consequences.

No one wants to take away an older person’s independence. Yet as a parent I cannot say I am fully comfortable with thousands of unassessed elderly motorists on the road.

We already do this informally whenever we see elderly patients

Now, Labour’s former deputy leader Harriet Harman has raised the possibility of GPs certifying older patients’ fitness to drive with Government ministers and the Commons Transport Select Committee; a suggestion that a lot of Pulse readers took against.1 But we already do this informally whenever we see elderly patients. If we had real concerns we would raise them – so why not take this a step further and make such assessments formal?

GPs are in a good position to do this since we, and our staff, have a good relationship with patients and a local surgery patients can easily attend instead of an assessment centre miles away. We might even get some of our own QOF checks (such as dementia monitoring and blood pressure) ticked off at the same time.

It should be pointed out that no fit and healthy motorist has any reason to be worried by this suggestion. If their memory and eyesight are good, and their reaction times and gross motor movement adequate, then their licence will not be revoked any more than a younger person’s would be. But it is the undetected poorly motorist that concerns me.

Clearly any suggestion to do this examination on every over-75 un-resourced cannot be workable. However, I believe there is a place for negotiation to allow this to take place and with proper time, organisation and funding we can make our roads a safer place.

Reference

1 Pulse (2017): GPs should certify over-75s’ fitness to drive every year, says Harriet Harman

Dr Justine Hall is a GP in Guildford, Surrey, and planned care clinical lead at NHS Guildford and Waverley CCG

matt piccaver square

NO

We are not best placed to make this complex assessment

We get asked for a lot of ‘GANFYDs’ as GPs. Get a note from your doctor for this, that and the other. I’m frequently asked to certify that a patient is fit for all manner of sports and activities, including a number that would readily test the structural integrity of bones, muscles and assorted internal organs.

But the suggestion that GPs should formally assess elderly patients’ fitness to drive is a step too far. Do we really need another activity to police? This would represent a significant increase in our workload. According to the DVLA, there are around 4.5 million drivers over the age of 70, and this number is likely to keep climbing in the future. Such a responsibility would be adding to the death by a thousand cuts that many GP colleagues already feel they are subjected to.

Do we possess the expertise to assess the complex thoughts, actions and reactions?

And who am I to judge? I’m not particularly good at parking. After attending two speed awareness courses I now drive my car as if it were made out of crystal. I am not sure we GPs possess the expertise to assess the complex thoughts, actions and reactions required to operate a car.

 

It’s true we do get asked if patients can drive with particular conditions. In such cases, the DVLA provides clear guidance in its ‘assessing fitness to drive’ document.1 Granted, there are many conditions it does not list, but at present the ultimate arbiter of whether a person can drive on medical grounds is the DVLA itself.

However, the question of reassessing whether a person can drive simply on the grounds of age is more complex. Morbidity and level of function vary vastly in many patients I see who are in their 70s. I meet fit and healthy people in this age range, so is it right to ask them to undergo an assessment simply because they are in this bracket?

I do not feel comfortable about being asked to decree whether a person is able to drive based on this criterion. But I know a group of people that can.

There are organisations, such as East Anglian DriveAbility (and others across the UK) that can provide a detailed, multidisciplinary assessment of a person’s driving. I would suggest such organisations are more ‘ideally placed’ to assess driving capacity than I am.

Reference

1 DVLA (2016): Assessing fitness to drive: a guide for medical professionals

Dr Matthew Piccaver is a GP in Sudbury, Suffolk

 

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Readers' comments (10)

  • doctordog.

    Key words here’ if. Properly. Sourced. ‘

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  • The devil is in the detail of that "if properly resourced":
    Even if practices were to receive money for these assessments, is it in the interests of the NHS and our patients to make the nation's GPs unavailable for usual clinical work for however long it takes to carry out potentially millions of driving assessments?

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  • I think that there is a risk of confusing two situations:
    Being asked to routinely 'police' the over seventies (for which we just don't have the time or skills).
    Turning a blind eye to patients whose families are terrified because dad or mum doesn't have the ability to drive 5 yards safely because of dementia or a major stroke.

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  • This would have to be more than a subjective decision. I assume that there is an evidence based examination that can be done which I as a GP have the skills and equipment to perform in a timeframe that is reasonable? Can someone point me in the direction of it please and I will have a look.

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  • Cobblers

    "GPs are in a good position to ..." No we are not.

    FFS we are inundated with work. Add to it, do.

    When you have finished with the over 75s make a start with the young men 17-25 year olds whose tendency to speed and over confidence in their own limited ability leads to crash fatality stats that puts the oldies in the shade.

    Maybe testosterone blockers with max engine

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  • Cobblers

    Got chopped!

    ... max engine

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  • Cobblers

    Seems that less than symbol cuts off end of passage!!

    ...max engine less than 600ccs and speed limiter. Add to the sex orientation and boiler checks!

    Academic, as AI driving will make this question redundant in a few years.

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  • NO

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  • That’s a medication review, observations,, checking for dementia, elder abuse and safeguarding, to see if they are depressed or a terrorist, now driving...of course all in the magic 10minutes!

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  • No! No! No! After a 12.5 hour day with no lunch / coffee / toilet break all day I do not have the time, nor the inclination..........

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