National review reignites fitness-to-drive assessment debate

Fitness-to-drive assessments are back in the spotlight, with calls for national consistency and the rollout of evidence-based tools to support GPs making the often-difficult decisions.

The National Transport Commission is currently assessing the Fitness to Drive Standards to ensure ‘decisions about health and licensing are fair, consistent and evidence based’.
 
The assessments have long been a cause of concern for many GPs, as they work through patients’ cognitive impairment, legal risks, and managing therapeutic relationships.
 
In response, an Australian Medical Association (AMA) submission said current discussions about fitness-to-drive assessments ‘often underestimate the responsibility placed on medical practitioners’.
 
‘Fitness-to-drive assessments require doctors, mostly general practitioners, to make decisions that directly affect a patient’s independence, employment, social participation and quality of life,’ it said.
 
‘At the same time, they must also consider broader public safety obligations.
 
‘This becomes particularly challenging when assessments involve progressive cognitive impairment, uncertainty regarding functional capacity, conflicting information from patients and families, or limited access to specialist assessment services.’
 
Amid these long-held concerns, the RACGP’s Silver Book, reiterates that the assessments can be challenging in general practice.
 
‘When determining an individual’s fitness to drive, a clinician’s input may have legal, ethical, emotional and social ramifications,’ it says.
 
The advice goes on to say determining fitness to drive must balance minimising any driving-related road safety risks for the individual and the community, and maintaining the driver’s lifestyle and employment-related mobility independence.
 
Professor Dimity Pond, a GP with a special interest in cognitive impairment, agrees that something needs to change, saying she has lost patients after they were unhappy with her assessment.
 
‘It ends up being subjective and it’s somewhat controversial with the patient and sometimes the family as well,’ she told newsGP.
 
‘Sometimes there’s real difficulties if the patient lives alone or if they’re the only driver, so it’s very challenging and you [may] have to be hard on the person.
 
‘If we could get something that said “no, you definitely can’t drive with this”, or “you may not be able to drive if you score higher, but you certainly can’t drive if you’re scoring below this mark”, that would be a help.’
 
The AMA’s submission goes on to name assessment of cognitive impairment as one of the most complex aspects of fitness-to-drive decision-making, with GPs ‘often required to piece together information from multiple imperfect sources’.
 
It says this can also impact the relationship between doctor and patient.
 
‘Unlike most clinical decisions, fitness-to-drive assessments can directly affect a person’s independence, employment, financial security, social participation and overall wellbeing,’ the AMA said.
 
‘Losing the ability to drive may have profound effects, particularly for older Australians, people living in regional or rural areas, and individuals who rely on their licence for work or caring responsibilities.’
 
In response, the AMA says further investigation of evidence-based tools that may improve consistency, objectivity and confidence in fitness-to-drive assessments is needed to help GPs conduct the consults.
 
The call for change comes as, according to Australian Infrastructure and Transport data, the number of licence holders aged 80 and older currently accounts for around 4% of drivers.
 
And the number of older drivers is rising rapidly – in 2025, there were 795,619 Australian drivers aged 80 and over compared to 460,273 a decade ago.
 
But Professor Pond said with this growing and ageing population, and long wait lists for non-GP specialists, the assessments are increasingly falling on GPs. 
 
‘A GP would like, in borderline cases, to refer the person to a geriatrician for assessment, but there are very, very long waiting lists these days – we’re looking at six months in a relatively good area and up to 12 months in a more under-doctored area,’ she said.
 
‘That’s adding pressure to GPs to make a decision, because you can’t wait that long before you let them drive or stop them driving.
 
‘We really, really need another system that doesn’t cost a fortune.’
 
The new Standards are expected to be published in 2028, with the current review aiming to ensure they are reflecting current clinical and road safety evidence and contemporary practice, including addressing ‘emerging medical, social and regulatory issues’.
 
The RACGP is currently consulting to identify key stakeholder issues which will inform the review process.
 
‘Further consultation will take place in 2027 once the revised Standards have been drafted,’ the college says.
 
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