Could backlog of medical assessments be creating a danger on the roads?

For GP practices, it is the perfect storm. On the one hand, soaring demand for HGV drivers has led to a surge in licence applications, each requiring medical certification from a doctor.

A shortage of HGV drivers had led to a backlog of medical assessments
A shortage of HGV drivers had led to a backlog of medical assessments

On the other hand, GPs are working flat out to deal not only with the coronavirus, but also the backlog of other conditions which have been put on hold due to the pandemic.

The result is that an estimated 200,000 drivers are now awaiting medical assessments for their licence applications – and a growing industry of private medical practitioners offering to bypass the waiting times at GP practices.

But while these fast-track medical appointments are popular with drivers and employers, the British Medical Association is warning of a potentially "grave impact" on road safety if assessments are carried out without full patient records.

The concerns have been backed by two West Midland doctors, who are calling for a shake-up of the way that these applications are handled.

Dr Jess Harvey says she can fully understand the need for more HGV drivers, but says GPs have to balance the need for these assessments with more pressing emergency work.

But she says fitness-to-drive assessments for such drivers are just as important as medical checks for gun licences, and should only be carried out by someone with full access to a patient's medical file.

"If the system is reliant on self-reporting, there is an opportunity for oversights, be it deliberate or otherwise," she says.

"I don't see it is any different to the gun licences, which are undergoing a review at the moment. If you have got somebody driving a large vehicle, you need to know for certain that they don't have any medical conditions that could affect public safety.

"You wouldn't give somebody a gun licence based on self-assesment."

Dr Harvey, who is based at the Much Wenlock and Cressage Medical Practice, says the answer probably lies in a system of specially licensed medical providers, who would have full access to patients' medical records.

"I think there is a need to overhaul this system," she says.

"If the Government isn't willing to provide us with extra funds, I think the best thing would be for the Department for Transport to have a few designated doctors who can access patients' records."

But Dr Satya Sharma, who is president of the Black Country division of the BMA, says such a measure would only go part of the way to addressing the problems.

"It only takes one small failure to result in a HGV killing 20 people," he says.

"Using private companies might clear the backlog, but what minister would like to have to explain the cause of 10 deaths because of a wrong decision?

"Giving independent doctors access to NHS records would be a step in the right direction, but it would not be perfect, they would not have the same knowledge of the patient as the medical practice."

The BMA has written to transport minister Baroness Vere calling for a "safety first" approach, voicing "concerns that this style of self-reporting is neither sensible nor safe" and calls for an approach that involves a person's GP.

The organisation also urges the authorities to be "honest" with people about the backlog and how long it will take to be addressed.

Dr Peter Holden of the BMA, says: "Only an individual's GP practices has access to a patient's full medical record, so only they know whether or not that person is fit to drive.

"By seeking 'sign-off' from an independent practitioner, who only has the patient's word to go by, there's a risk that medical conditions may be, either intentionally or unintendedly, understated and this has already had a grave impact on road safety.

"With this in mind, the Government must ensure that there is a process in place to involve an applicant's GP."

Shrewsbury-based GP Dr Mary McCarthy, vice-chairman of West Midlands BMA, agrees.

"Only the patient's GP has the full medical record and the DVLA need to be clear with the public about this and about how long the backlog will take to clear," she says.

Shrewsbury-based D4Drivers is the UK's biggest provider of independent medical assessments for commercial drivers. Commercial manager Tom Blain agrees there is scope for improvement in how medicals are provided, the solution was not to put more pressure on the NHS.

"The NHS is not the solution to the crisis which NHS primary care is facing and the impact that the pandemic has had on their ability to provide services such as driver medicals," he says.

"Long before the Covid pandemic, drivers began opting to book their medical with reputable independent firms such as ours rather than with their GP surgery because they were fed up with long waiting times and extortionate prices for what is a straightforward assessment.

"Indeed we are aware of some GP surgeries pricing this service in such a way as to discourage drivers from booking with them, such was the pressure to provide essential services and meet targets. In that environment, drivers sought an alternative. GP surgeries simply weren’t able to provide this service effectively before the pandemic, and they especially cannot do so now, post-Covid.

"We don’t agree that by arranging their medical with an independent doctor, drivers are in any way trying to exploit the current situation – their decision is driven by reasonable expectations of customer service and a timely appointment. I

"Many drivers contact us in a panic because their licence is due to expire and they can’t get an appointment with their GP in time."

Mr Blain said all doctors at D4Drivers were specifically trained to complete these medicals and were subject to checks by mystery shoppers, with many doctors performing hundreds of checks each year.

"Compare that to a GP who maybe completes a few each year and has had no formal training on how to do so and you can see why we are confident in asserting that it is not always the GP who is always the best person to assess fitness to drive," he adds.

Mr Blain agrees that more could be done to improve road safety, saying that it was possible for an HGV driver to gain their licence at 18, and then go 27 years before having another medical at the age of 45.

"Even in their 40s, 50s and early 60s drivers are only having a medical every five years, in which time their health is changing dramatically," he says, adding that the company now offers a screening service with annual assessments if required.

The DVLA says extra staff and evening shifts are helping to tackle the backlog.

"We welcome the decision by the BMA and Royal College of GPs to review DVLA medicals after they were temporarily deprioritised during the pandemic," said a spokesman.

"By law, all drivers must meet medical standards for fitness at all times, and there are additional checks for bus and lorry drivers."

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