Assessing Fitness to Drive

In this section

4.4.1. What is a conditional licence?

4.4.2. Who allocates a conditional licence?

4.4.3. What is the role of the health professional?

4.4.4. What sort of conditions/ restrictions may be recommended?

4.4.5. What monitoring is required for a conditional licence?

4.4.6. What about conditional licences for commercial vehicle drivers?

4.4.7. What if there is a delay before a specialist can be seen?

A conditional licence provides a mechanism for optimising driver and public safety while maintaining driver independence when a driver has a long-term or progressive health condition or injury that may affect their ability to drive safely. A conditional licence permits the driver to drive in conditions that suit their capability – for example, no night driving, only driving in familiar areas (local area restriction) or having to wear corrective lenses. A conditional licence identifies the need for medical treatments, vehicle modifications or driving restrictions that would enable the person to drive safely. It may also specify a review period, after which the person must undertake a medical review to establish the status of their condition and their continued fitness to drive. A conditional licence therefore offers an alternative to withdrawing a licence and enables individual case-based decision making.

The final decision regarding conditional licences rests with the driver licensing authority (refer to section 3.1. Roles and responsibilities of driver licensing authorities). The decision is based on information provided by the driver’s health professional and on-road safety considerations. The driver licensing authority will issue a conditional licence to a driver with a long-term injury or illness on the basis that any additional road safety risk posed by the person driving is acceptable.

While the driver licensing authority makes the final decision about whether a driver is eligible for a conditional licence, the health professional provides information to assist the authority in its decision making. The health professional should advise the driver licensing authority of:

• which medical requirements (for an unconditional licence) have not been met (referring to medical criteria/thresholds outlined in this document)
• the likely adequacy of treatments, driver aides or vehicle modifications in optimising driver capacity
• the plan to monitor the driver’s performance and the medical condition, including timeframes for review
• if appropriate, information relating to possible licence conditions – for example, vehicle type or licence restrictions such as no night driving, radius restriction or downgrading to a lower class of licence
• any other medical information that may be relevant to the driving task.

This information is needed so the driver licensing authority can make an informed decision and determine what conditions will be endorsed on the licence.

Examples of licence conditions, restrictions or vehicle modifications are shown in Table 4 Examples of licence conditions that may be required by the driver licensing authority. These are indicative only and will vary depending on the medical condition and the type of licence. They include standard conditions that will appear as codes on the driver licence (e.g. corrective lenses, automatic transmission, hand controls). They also include conditions that are ‘advisory’ in nature and as such may not appear on the actual licence (e.g. take medication as prescribed, don’t drive more than a specified number of hours in any 24-hour period).

One option available to maintain a driver’s independence despite a reduction in capacity is to recommend that an area restriction be placed on the licence. This effectively limits where the person can drive and is most commonly expressed as a kilometre radius restriction based on their home address. Drivers should be capable of managing usual driving demands (e.g. negotiating intersections, giving way to pedestrians) as required in their local area. These licence conditions are only suitable for drivers who can reasonably be expected to understand and remember the limits as well as reliably compensate for any functional declines. The ability to respond appropriately and in a timely manner to unexpected occurrences such as roadworks or detours that require problem solving should also be considered. Individuals lacking insight or with significant visual, memory or cognitive-perceptual impairments are usually not suitable candidates for a radius restriction (e.g. refer to Part B section 6.1. Dementia).

The health professional can support a patient in making an application for a conditional licence by indicating the patient’s driving needs, but the final decision rests with the driver licensing authority.

* These are not mandatory requirements and may be unsuitable in some circumstances.

Conditional licences should be subject to periodic review so the medical condition, disability or treatment, including the compliance with treatments, can be monitored. The frequency of formal review regarding licence status is sometimes specified in this publication but often is left to the judgement of the health professional, given the variations in severity and stability of a medical condition, disability or treatment and the possible effects on driving.

In the course of providing advice about a conditional licence, health professionals should advise the driver licensing authority of the period for which a conditional licence could be issued before formal review. This may be months or years depending on the condition in question and its progression; these reviews differ from the ordinary follow-up consultations that a health professional may be offering in the course of general management.

At the time of a periodic review or during general management of a patient’s condition, it may become apparent that the patient no longer meets the requirements of the conditional licence because their health has deteriorated for some reason. The patient should be advised to inform the driver licensing authority of their changed circumstances with respect to fitness to drive (refer to section 3.2. Roles and responsibilities of drivers).

In addition to the examples in Table 4, the driver licensing authority may consider issuing a conditional commercial vehicle licence – for example, in certain circumstances or situations where crash risk exposure can be managed. A case-by-case risk assessment is required that considers relevant factors including driver insight, stability of the health condition, treatment compliance, nature of goods being transported, size/complexity of the vehicle and periodic review requirements. Examples of such circumstances or situations may include:

• off-road driving of commercial vehicles where licences are still required
• where driving is not the primary occupation – for example, mechanics who need to test drive the vehicle, primary producers who need to get product to market and only need to drive a couple of times a year and drivers who need to move buses not carrying public passengers within a bus depot or from a nearby workshop.

In the case of commercial vehicle drivers, the opinion of a medical specialist is generally required for consideration of a conditional licence – the main exceptions to this are set out in the next paragraph and in section 4.4.7. What if there is a delay before a specialist can be seen?. This requirement reflects the higher safety risk for commercial vehicle drivers and the consequent importance of expert opinion.

In areas where access to specialists may be difficult, the driver licensing authority may agree to a process in which:

• initial assessment and advice for the conditional licence is provided by a specialist
• ongoing periodic review for the conditional licence is provided by the treating general practitioner, with the cooperation of the specialist.

Where appropriate, telemedicine is encouraged to facilitate access to specialist opinion.

In the case of a commercial vehicle driver or applicant for a commercial vehicle licence who is assessed by a general practitioner as not meeting the criteria to hold an unconditional licence for one or more conditions but who may meet the criteria to hold a conditional licence, the driver licensing authority may permit the person to drive, or to continue to drive, a commercial vehicle pending assessment of the person by an appropriate specialist(s) if:

• the person has an appointment to see the relevant specialist(s) at the earliest practicable opportunity
• in the opinion of the general practitioner the condition is not, or the conditions are not, likely to lead to acute incapacity or loss of cognitive ability or insight before the assessment or assessments occur.

Examples of such conditions include early peripheral neuropathy, early rheumatoid arthritis or diabetes treated by diet and exercise alone. Examples of conditions that could lead to acute incapacity or loss of concentration include ischaemic heart disease, sleep apnoea and blackouts (other than vasovagal).

In applying this section the driver licensing authority may impose conditions on the licence.