When to override the confidentiality of unsafe drivers

The guidance covers various scenarios where this may be required and includes providing information when requested by external organisations, such as the police or the courts, or where there may be a need to report suspected abuse. There is also a particular focus on vision and safe driving, where a registrant may need to disclose information if a patient is unfit to drive.

There have been a number of high-profile media stories in recent years involving accidents or fatalities by drivers who continued to drive against the advice of their optometrist

The Driving & Vehicle Licensing Authority (DVLA) in England, Scotland and Wales, and the Driving & Vehicle Authority (DVA) in Northern Ireland, are legally responsible for setting the medical standards of fitness to drive including vision standards, and for deciding if a person is medically fit to drive. The licence holder has a legal responsibility to notify them of any medical condition that may affect safe driving, including advice from an optometrist that details that they fall below the vision standards required for safe driving.

The DVLA publishes guidance for healthcare professionals, Assessing fitness to drive – a guide for medical professionals, which includes the minimum medical and vision standards required to hold a driving licence. It contains extracts from guidance produced by the College of Optometrists aimed at supporting optometrists in referral decisions. It also includes guidance from the General Medical Council (GMC), aimed at supporting doctors in referral decisions.

Eroding trust

There have been a number of high-profile media stories in recent years involving accidents or fatalities by drivers who continued to drive against the advice of their optometrist or GP. Some of the victims’ families asked the Government to introduce new legislative requirements so that healthcare professionals automatically notify the DVLA or DVA when a patient is unfit to drive, regardless of whether a patient has given consent to share their records.

We hope our new guidance will help empower our registrants

In response, the GMC updated its guidance in April 2017 to more clearly reflect the doctor’s duty to protect the public from risk of harm, but did not support creating any new requirements on doctors to automatically notify the DVLA or DVA if a patient is unfit to drive, as this would have wider implications in terms of eroding trust in the doctor-patient relationship.

The GOC has also been doing work in this area to gain a better understanding of the issues affecting its registrants in relation to decisions to override confidentiality, particularly in reporting to the DVLA or DVA when there is a concern.

We undertook independent research, which is available on our website, that showed that 18% of registrants were unaware of the DVLA guidance and that 72% of registrants would not feel comfortable informing the DVLA or DVA about a patient’s vision if the patient could not or would not do it themselves. This highlighted that further guidance was needed in this area to support the profession.

The GOC council will consider the outcomes of the consultation in November with a recommendation that the guidance be launched in December 2019. Supporting activities to raise awareness and assist implementation would follow.

We hope that our new guidance will help empower our registrants to be confident in determining when it is appropriate for them to disclose information in the public interest.

Read the GOC’s statement about reflective learning in healthcare.

Marcus Dye is the GOC’s head of standards and CET.

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