DVLA guidance updated November 2025 - all timeframes and requirements reflect current standards
Driving & Flying for GPs: Your Survival Guide
Navigate DVLA rules without crashing your consultation - no flight delays included! ✈️
Date Updated: December 9, 2025
Executive Summary
Because you have 47 other things to do before lunch, and that's just the morning list
What This Page Covers:
- • D-R-I-V-E framework for DVLA decisions
- • CRASH rule - when patients must stop driving
- • High-yield conditions & timeframes
- • CABIN mnemonic for fitness to fly
- • Quick revision checklists
- • Medicolegal duties & documentation
Quick Facts at a Glance:
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Brainy Bites: Essential Driving & Flying Wisdom
Golden Rules
You advise, DVLA decides - Document what you said, not what you think they should do
Driver's duty - It's legally their responsibility to notify DVLA and insurer
When in doubt, check it out - The DVLA guide is your best friend
Safety-net always - "If anything changes, stop driving and seek advice"
Red Flags
Any unexplained collapse - Stop driving immediately until cause found
Severe hypo while driving - Must stop and notify DVLA
Can't read number plate at 20m - Must not drive
Patient refuses to stop when unsafe - Consider breaking confidentiality
Facts to Help You Remember
10 high-yield, memorable real-world facts that GPs consistently find useful
1 After a first unprovoked seizure, the recurrence risk ≈ 40–50% in 1 year
This is exactly why DVLA requires 6–12 months off driving.
The risk drops significantly after 6 months if MRI/EEG are normal — hence the "6-month" pathway for low-risk individuals.
2 Driving after a TIA/stroke: 1 month off = because recurrence is 10–15% within 1 month
Most recurrent ischaemic events occur in the first 7–14 days.
By 1 month, the recurrence risk falls enough for DVLA to permit Group 1 return if symptoms have resolved.
3 A severe hypoglycaemia episode increases crash risk x5 for the next 12 months
This is why ANY severe hypo while driving = must notify DVLA.
Up to 1 in 4 drivers with diabetes admit to at least one hypo while driving in the last year.
4 Visual field defects account for only ~2–3% of referrals to DVLA but cause a disproportionate number of revocations
The number-plate and Snellen tests are only part of fitness to drive.
Bitemporal hemianopia, advanced glaucoma, and post-stroke field loss are among the commonest causes of licence loss.
5 After uncomplicated pacemaker insertion, >95% of patients have adequate cardiac stability within 7 days
This underpins the simple DVLA rule:
✔ 1 week off, notify DVLA
✔ No need to notify for box change
In ICDs, risk varies far more — hence 1–6 months depending on indication/shocks.
6 Seatbelts reduce the risk of death in a crash by 40–50%
For front-seat occupants: Death risk reduced by 45%, Serious injury reduced by 50%
For rear-seat passengers: Death risk reduced by 25–30%. Still one of the most effective safety measures ever created.
7 Speeding dramatically increases fatality risk — especially above 70 mph
Travelling at 80 mph instead of 70 mph increases crash fatality risk by ~30%. At 90 mph increases it by ~80%
Stopping distance at 70 mph: 96m. At 80 mph: ~121m (25m more). A 10–20 mph increase can double the force of impact.
8 1 in 4 UK road deaths involve excess speed (25%)
Speeding contributes to ~25% of all fatal crashes and 15% of all serious injuries
Useful stat when counselling patients with risky driving behaviour.
9 Around 20% of UK drivers admit to microsleeping at the wheel at least once
Microsleeps last 2–10 seconds. At 70 mph, a 5-second microsleep = travelling blind for 150 metres
Fatigue = one of the commonest hidden causes of motorway crashes.
6 Cabin pressure ≈ the altitude of 6,000–8,000 ft → oxygen falls equivalent to 15–17% FiO₂
Even healthy passengers drop their SpO₂ by 3–5%.
Those with COPD, heart failure, anaemia or post-MI may drop much more. This is why airlines may require supplemental oxygen.
7 Gas expands by ~30% at cruising altitude → the "surgical gas & pneumothorax rule"
A gas pocket expands to 1.3× size at altitude. This is why:
✔ Active pneumothorax = must not fly
✔ After resolution, airlines usually require 7 days–2 weeks before flying
✔ Caution after laparoscopy / colonoscopy (24h rule)
8 VTE risk doubles on flights >4 hours — but the absolute risk is tiny (~1 in 4,600)
Baseline: ~1 in 10,000 risk of DVT in the community per year. After long-haul (>8 hours), risk increases to 1 in 4,600 in healthy individuals.
Risk is much higher if: Previous DVT/PE, Active cancer, Pregnancy, Oestrogen therapy, Immobility
This is why simple measures (hydration, movement, compression) matter.
9 Only 15–20% of pneumothoraces cause symptoms during flying — but when they do, deterioration can be rapid
Most asymptomatic pneumothoraces remain stable.
However, expansion at altitude can convert a small pneumo → tension physiology. Hence the conservative "7 days after full radiological resolution" recommendation.
10 After an uncomplicated MI, >80–90% of patients are safe to fly by day 7–10
This correlates with stabilisation of myocardium, peak inflammatory period passing, and lower risk of arrhythmia.
Complicated MI, low EF, or arrhythmic events significantly extend this timeframe to 4–6 weeks.
11 Pregnancy & Flying – the simple rule
Uncomplicated singleton pregnancy: Short-haul until 36 weeks, Long-haul until 32 weeks
Twin pregnancy: many airlines restrict after 28 weeks. Always check that airline's rules — they vary slightly. Airlines often require a "fit-to-fly" letter after 28 weeks.
12 The chance of a medical emergency on your flight
Around 1 medical emergency per 600 flights. Equivalent to 1 in 40,000 – 1 in 50,000 passengers
Most common reasons: syncope, breathlessness, GI upset, cardiac symptoms. Only 1 in 8 million passengers dies in-flight — extremely rare, but it does happen.
13 Only 0.3–0.5% of flights divert for medical reasons
Meaning fewer than 1 in 200–300 medical events lead to a diversion.
Diversions cost airlines £20,000–£500,000, so medical clearance is taken seriously.
14 Long-haul flight ≥8 hours roughly doubles the risk of DVT
Baseline annual risk: approx. 1 per 10,000 adults. After long-haul: approx. 1 per 4,500–5,000 travellers
But risk is 10–40× higher if there are additional VTE risk factors (recent surgery, cancer, pregnancy, HRT, thrombophilia).
15 Up to 50% of commercial aircraft emergencies are due to syncope or presyncope
The reduced cabin pressure (equivalent to 6,000–8,000 ft) triggers mild hypoxia → vasodilation and dehydration → fainting.
Useful when assessing borderline fitness to fly.
16 Asthma attacks triggered by flying are uncommon – <1%
Because the cabin is filtered and temperature-controlled.
Most respiratory events in flight are due to COPD, heart failure, or panic, not asthma.
⭐ BONUS: 5 ultra-fast facts trainees love
These are commonly asked in GP teaching:
Diabetics on insulin driving a bus/lorry (Group 2): Only ~1 in 20 applicants meet the strict criteria
Hypo unawareness excludes almost everyone. Any hypo requiring assistance = automatic removal.
Stroke → visual field loss: up to 30% have permanent deficits affecting driving
Many never meet DVLA standards again.
Up to 50% of airline "medical incidents" are fainting, anxiety, or GI issues — NOT cardiac problems
Helps when assessing borderline cases in GP.
1 in 5 COPD patients desaturate below 85% on altitude simulation testing
Good to remember when deciding on oxygen referral.
Fear of flying affects ~20–25% of the population
Useful when distinguishing anxiety vs true medical risk.
🎆 BONUS: 2 even more "wow" facts for your teaching slides
The risk of medical help being needed on your flight is higher than the risk of the plane crashing by a factor of 10,000+
Flying is extremely safe — it's the passengers' health that causes trouble, not the aircraft.
Wearing a seatbelt in the back seat reduces the risk of killing someone else in the front seat by up to 80%
Unrestrained rear passengers are deadly projectiles in a crash.
1. Big Picture – DRIVING (DVLA)
D-R-I-V-E Framework: Core Principles
Easy to remember framework for DVLA decisions
2. The "CRASH" Rule – Must Stop Driving (Group 1)
CRASH Mental Checklist
When patients must definitely stop driving immediately
"You must stop driving now. You may need to tell DVLA and your insurer. I'll check the DVLA guidance and document what we've discussed."
3. High-Yield Conditions & Timeframes
Key Conditions with Timeframes (Group 1 Focus)
Exam-friendly rules of thumb - always check DVLA guide for exact details
First Unprovoked Seizure
- • Stop driving immediately and notify DVLA
- • 6 months off if low risk and investigations reassuring
- • 12 months if underlying risk factor or higher recurrence risk
- • Group 2: almost always long-term or permanent loss
Established Epilepsy
- • Must notify DVLA
- • Group 1: usually 12 months seizure-free
- • Group 2: usually 10 years seizure-free off medication
TIA and Stroke
- • Single TIA (fully recovered): No driving for 1 month
- • No need to notify DVLA for Group 1 if fully recovered by 1 month
- • Stroke: At least 1 month off; longer if residual deficit
- • Notify DVLA if neurological deficit persists beyond 1 month
Syncope / TLOC
- • Any unexplained TLOC or syncope → stop driving and assess
- • Restrictions depend on cause (vasovagal vs arrhythmia vs seizure)
- • Simple vasovagal with clear trigger usually less restrictive
- • Any event while sitting or driving treated much more seriously
Myocardial Infarction / PCI (Group 1)
- • Uncomplicated MI treated medically: Stop driving for 4 weeks
- • Elective or uncomplicated PCI: Stop driving for 1 week
- • Don't need to notify DVLA if no other disqualifying issues
- • Complicated MI/heart failure/arrhythmias: Longer restrictions
Angina
- • Can drive if symptoms only on moderate exertion, stable
- • Must stop if angina at rest, with emotion or while driving
- • Can resume once symptoms controlled
Pacemakers and ICDs
- • Pacemaker (first implant): Stop driving for 1 week, notify DVLA
- • ICD: typically 1-6 months off depending on indication
- • Must notify DVLA for ICD
- • Group 2: generally permanent revocation for ICD
Heart Failure
- • Group 1: may drive if no symptoms at rest, no disabling arrhythmias
- • Severe HF (NYHA III-IV, LVEF <40%) can trigger restrictions
- • Group 2: much stricter - moderate HF often debars licence
• Severe hypoglycaemia = requires help from another person
• Hypo unawareness = can't recognise low glucose due to lack of warning symptoms
Group 1 Rules of Thumb
- • Any severe hypo while driving → must stop driving and notify DVLA
- • Recurrent severe hypos while awake (≥2 in 12 months) → stop and notify DVLA
- • Hypo unawareness → must not drive; licence restored once awareness returns
Insulin-Treated Diabetes
- • Must inform DVLA at start of insulin therapy (esp. Group 2)
- • Must monitor glucose regularly when driving
- • Always carry carbs
Group 2 (Bus/Lorry)
- • One severe hypo in 12 months → generally no Group 2 licence
- • Any hypo unawareness → generally no Group 2 licence
Key DVLA Eyesight Rules (Group 1)
- • Must read number plate at 20m (post-2001 plate, good daylight)
- • Visual acuity at least 6/12 Snellen with both eyes open
- • Need adequate visual field (≥120° horizontally)
- • No central scotoma within 20° of fixation
Must Tell DVLA About:
- • Problems affecting both eyes (or only remaining eye)
- • Glaucoma in both eyes
- • Significant field loss
- • Certification as sight-impaired
If they can't meet the number-plate test → they must not drive and must notify DVLA
Triggers to Think "No Driving"
- • Psychosis, mania, severe depression with suicidal ideation
- • Major cognitive impairment affecting judgement or reaction
- • Alcohol or drug dependence/misuse
- • Sedating medication impairing driving ability
Medication Considerations
- • High-dose benzodiazepines
- • Strong opioids
- • Individual risk assessment needed
- • Consider cumulative effects
Your Medicolegal Duties
- • Consider driving whenever you diagnose/treat something that could impair driving
- • Advise the patient clearly if they should stop driving and/or notify DVLA
- • Document the exact advice you gave
If Patient Refuses to Follow Advice
- • Try again, explaining risks
- • If still unsafe, you may need to break confidentiality
- • Inform DVLA in the public interest
- • Must warn patient you are doing so
4. Flying ("Fit to Fly") – Simple GP Framework
CABIN Mnemonic – Things to Think About
You're not the final decision-maker – airlines have their own medical advisors
GPs are not contractually obliged to issue "fit to fly" letters. Instead, provide factual summaries of current condition and treatment.
Typical Time-frames for Flying (Rule-of-thumb)
Always cross-check airline policy and consider individual risk
Cardiac
- • Uncomplicated MI: often safe after 7-10 days once stable
- • Complicated MI/heart failure: often need 4-6 weeks
- • Elective PCI: may be fit after a few days if stable
- • CABG: usually 7-14 days minimum, must be mobile
Respiratory
- • Pneumothorax: Do not fly with active pneumothorax
- • Wait 7 days after full radiological resolution
- • Often 2 weeks after chest drain removal
- • COPD: If SpO₂ <92% at sea level, consider oxygen
Recent Surgery
- • Abdominal surgery (open): commonly 10 days+
- • Must be mobile and free of major complications
- • Laparoscopy/colonoscopy: 24 hours minimum
Special Situations
- • Pregnancy: Usually fine up to 36 weeks (short-haul)
- • DVT/PE: 2-4 weeks on anticoagulation
- • Infectious disease: Must be non-infectious
Practical GP Approach to "Can I Fly?"
1. Is it safe in the cabin?
Cabin pressure ≈ 6-8,000 ft altitude → mild hypoxia and gas expansion
- • Can they walk 50-100m or climb stairs without severe symptoms?
- • Any chest pain at rest or with minimal exertion?
- • Current oxygen saturations and respiratory stability?
2. Could they deteriorate in flight?
- • Recent MI, unstable angina, uncontrolled arrhythmia
- • Active infection, significant confusion
- • Behaviour disturbance
3. What does the airline need?
- • MEDIF form and/or brief factual letter
- • Diagnosis, current status, medications
- • Any special requirements (oxygen, wheelchair)
- • Make clear you're not guaranteeing future safety
"On [date], I assessed [Name, DOB]. They have [diagnoses], currently [stable/unstable, functional capacity]. They take [meds]. There are [no/some] recent complications. Decisions about fitness to fly rest with the airline's medical team, who will consider this information alongside their policies."
5. Memory Aids & Quick Revision Checklist
For DRIVING – 10 Questions
- 1. What group? Car (G1) or bus/lorry (G2)?
- 2. Any CRASH trigger?
- 3. Is the condition stable?
- 4. Any recent severe hypo or hypo unawareness?
- 5. Can they see? (20m number plate + 6/12 acuity)
- 6. Any cognitive/psychiatric/substance issues?
- 7. Is there a clear DVLA rule?
- 8. Have I clearly told patient to stop if needed?
- 9. Have I mentioned DVLA & insurer notification?
- 10. Have I documented what I advised?
For FLYING – 5 Fast Checks (CABIN)
- C – Clot risk: recent DVT/PE, cancer, immobility?
- A – Air: pneumothorax? recent surgery with trapped gas?
- B – Breathing/heart: stable COPD/asthma/HF? saturations?
- I – Infarction/Ischaemia: recent MI, stroke, arrhythmia?
- N – Neuro & infection: confused? agitated? infectious?
Then ask: "Is there a clear reason they should not fly now, and do we need a specialist view or airline medical clearance?"
You've Got This! 🚗✈️
Remember: You don't need to be a transport specialist to provide excellent driving and flying advice. You just need to know when to worry, when to advise stopping, and when to check the guidelines.
Keep the DVLA guide bookmarked, use your mnemonics, document everything, and trust your clinical judgement. Most importantly - when in doubt, look it up and ask for help!