Fitness to drive updates: What GPs need to know

In 2021, people aged 75 and older had the second highest road fatality rate of any age group in the country (seven deaths per 100,000 people), only marginally behind people aged 17–25 (7.4 per 100,000).
 
And while efforts to make Australian roads safer have resulted in progress across a number of statistical areas, the number of driver and motorcycle rider deaths among people aged 65 and older has actually increased by 19.3% since 2008–10.
 
The high road toll is one of the reasons why University of Adelaide Professor Nigel Stocks, the RACGP representative on the Assessing Fitness to Drive Implementation Advisory Group, believes GPs should ‘at the very least’ review incoming changes to the new Assessing Fitness to Drive 2022 standards, which have been approved as an RACGP Accepted Clinical Resource. 
 
‘When faced with more complex patients, taking the time to read the relevant chapter will make GPs’ decision fairer to the patient and community,’ he told newsGP. 
 
‘We should also be engaging, most often with older patients, about the effect that their condition or disability may have on their ability to drive safely both now and in the future.
 
‘Whilst adverse decisions may be reluctantly accepted by some patients, there are avenues for further assessment, including practical driving tests and allied health referral if required.’
 
For nearly the past five years, GPs and other healthcare professionals have been using the Austroads Assessing Fitness to Drive 2016  standards to guide them in making decisions on their patients’ health status and ability to drive safely, with the last amendment being made in August 2017.
 
But from 22 June 2022, a new edition will come into effect. From that date, all medical assessments and decisions determining a person’s fitness to drive must be based on these updated standards.
 
A number of changes come with the new edition standards, including the important role of healthcare professionals in advising drivers about the impact of their medical conditions and/or disabilities on driving in the short- and long-term, and drivers’ reliance on this advice.
 
The importance of ‘early and repeated’ conversations about driving for people diagnosed with progressive conditions is also referenced, and Professor Stocks says GPs are integral in this field of evaluation and decision making.
 
‘Assessing fitness to drive is an important, actually vital, role for doctors and other health professionals to ensure the safety of our patients and the wider community,’ he said. 
 
‘GPs are a trusted source of advice to patients, and although families and friends are important when decisions about driving are made, it is often what we say, or recommend, that will have the greatest impact.
 
‘In my personal experience as a GP, being able to reference the standards helps patients better understand the recommendations being made and makes our role clearer.’
 
So, what do GPs need to be aware of as part of their role in assessing fitness to drive?
 
The updated standards detail the importance of information sharing between healthcare providers, including GPs, other specialists, optometrists and occupational therapists.
 
Such an approach is designed to ensure appropriate care coordination for road safety, as assessing fitness to drive requires multidisciplinary management – particularly for older drivers, and drivers with disability or multiple medical conditions.
 
There have also been countless advances in healthcare since the last edition of the standards, such as new research on implantable cardioverter defibrillators (ICDs), improved and earlier detection of dementia, and the ability to prescribe medicinal cannabis for various conditions. 
 
This is important, as criteria in Assessing Fitness to Drive 2016 excluded drivers with ICDs from holding a commercial vehicle licence, partly due to the underlying condition, but also due to the ‘risk of incapacitation due to inappropriate discharge of the device’.
 
But, as part of the development of the new standards, research was reviewed that suggests ‘lower rates of shock frequency and syncope in patients where an ICD is used for primary prevention’.
 
Therefore, new criteria for conditional licensing are set in the 2022 edition for this group of patients with commercial licences, specifying a ‘non-driving period post-implantation’ (six months) and an annual review period.
 
Meanwhile, with medicinal cannabis being prescribed more frequently in Australia, the new standards include comprehensive information to guide decisions about driving for this patient cohort, including potential safety impacts.
 
‘These [two examples] and other changes have implications for patients’ fitness to drive, so the standards have to reflect these advances and changes in healthcare,’ Professor Stocks said.
 
Assessing Fitness to Drive 2022 also outlines the responsibilities of drivers, examining healthcare professionals and licensing authorities.
 
The legal obligations of drivers, health professionals and licensing authorities remain unchanged, and it is licensing authorities – not healthcare professionals – which make the ultimate decision about whether a person will be able to hold a licence.
 
However, the standards acknowledge the important role of healthcare professionals in advising patients about the impact of their health conditions, treatments, or disabilities on safe driving. This allows drivers to fulfill their responsibility to report to the driver licensing authority any permanent or long-term condition likely to affect their ability to drive safely.
 
‘The standards provide guidance to GPs when making a driver assessment,’ Professor Stocks said. 
 
‘They are based on relevant research evidence and the best medical and health professional advice.’ 
 
The Assessing Fitness to Drive 2022 edition will be released on 22 June. A summary of changes is available now on the Austroads website.
 
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