A practice in the Greater London area

6. Mr J complains a GP at the Practice incorrectly insisted that he tell DVLA about a time when he lost consciousness in May 2022.

7. He also complains the Practice:

• broke ‘the law’ by not keeping a copy of the medical questionnaire it sent to DVLA • did not send the cardiology report to DVLA (which confirmed he had no issues with his heart) at the same time as the questionnaire • removed him from its patient list.

8. He says:

• he was unable to continue in his job as a coach driver which meant a loss of earnings and he will find it difficult getting a similar job in the future • he was unable to appeal his licence being suspended • losing his licence and the Practice removing him as a patient was distressing.

9. He would like compensation for loss of a year’s earnings (£50,000) and to be put back as a patient at the Practice.

10. On 10 May 2022, after an episode of undiagnosed loss of consciousness, Mr J visited the Practice for a check-up.

11. Mr J says he had been working 100 hours a week and after getting up suddenly, he felt a rush of blood to the head.

12. A GP at the Practice arranged investigations and an urgent cardiology referral. The GP also advised Mr J that as a class 2 coach driver, he was legally required to tell his employer and DVLA about the loss of consciousness. A class 2 driver is someone who is qualified to drive vehicles of over 3,500kg.

13. A few days later, the Practice said Mr J told the GP that he would not tell his employer and DVLA. The GP advised that if he did not, they were obliged to. Mr J then told DVLA.

14. On 10 August, DVLA wrote to Mr J to tell him he could continue to drive as long as he had no more issues. At the same time, DVLA also asked a GP at the Practice to complete a medical questionnaire for Mr J’s fitness to drive.

15. On 22 August, the GP told Mr J about the contents of the questionnaire. He agreed the GP could send it, which they did the same day.

16. The cardiology report arrived at the Practice the next day. The Practice sent a copy of this to Mr J. It told us it did not send a copy to DVLA.

17. On 12 September, Mr J called the Practice to complain because DVLA suspended his licence. His employer had also made him redundant, although this was not related to the referral to DVLA. The GP explained it was a legal requirement and they had no control over this. They gave Mr J a website link to appeal DVLA’s decision.

18. Mr J asked for a copy of the questionnaire the GP sent to DVLA, but unfortunately, staff had not scanned it before it was sent. The GP suggested Mr J could get a copy himself from DVLA.

19. On 3 October, the Practice said the GP also helped Mr J to complete the appeal form.

20. Mr J says if the Practice had been able to give him the questionnaire it sent to DVLA, he could have appealed the suspension of his licence at court. An appeal must be made within 21 days of the suspension. Mr J told us DVLA said it would take at least 30 days to give him a copy of the questionnaire.

21. The Practice removed Mr J from its patient list as it said he had been abusive and threatening. It told him about this on 14 December.

24. Before we decide if we should do a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. If there are signs something has gone wrong, we then look to see if this has had a negative effect which the organisation has not put right.

Telling DVLA about Mr J’s loss of consciousness

25. DVLA standards say:

‘Applicants and licence holders have a legal duty to:

• notify DVLA of any injury or illness that would have a likely impact on safe driving ability (except some short-term conditions that are unlikely to continue beyond 3 months, as set out in this guide)’.

‘Doctors and other healthcare professionals should:

• advise the individual on the impact of their medical condition for safe driving ability • advise the individual on their legal requirement to notify DVLA of any relevant condition • notify DVLA directly of an individual’s medical condition or fitness to drive, where they cannot or will not notify DVLA themselves. In law, it is the duty of the licence holder or applicant to notify DVLA of any medical condition that may affect safe driving.

Circumstances may arise in which a person cannot or will not notify DVLA. It may be necessary for a doctor, optometrist or other healthcare professional to consider notifying DVLA under such circumstances if there is concern for road safety, which would be for both the individual and the wider public’.

26. GMC guidance says:

‘1. Trust is an essential part of the doctor-patient relationship and confidentiality is central to this. Patients may avoid seeking medical help, or may under-report symptoms, if they think that their personal information will be disclosed by doctors without consent, or without the chance to have some control over the timing or amount of information shared.

60. Doctors owe a duty of confidentiality to their patients, but they also have a wider duty to protect and promote the health of patients and the public.

62. You [doctors] should ask for a patient’s consent to disclose information for the protection of others unless it is not safe or practicable to do so, or the information is required by law. You should consider any reasons given for refusal.

64. If it is not practicable to seek consent, and in exceptional cases where a patient has refused consent, disclosing personal information may be justified in the public interest if failure to do so may expose others to a risk of death or serious harm.

68. If you consider that failure to disclose the information would leave individuals or society exposed to a risk so serious that it outweighs patients’ and the public interest in maintaining confidentiality, you should disclose relevant information promptly to an appropriate person or authority. You should inform the patient before disclosing the information, if it is practicable and safe to do so, even if you intend to disclose without their consent’.

27. Later sections of this guidance also apply to Mr J’s circumstances and say:

‘3. The Driver and Vehicle Licensing Agency (DVLA) in England, Scotland and Wales and the Driver and Vehicle Agency (DVA) in Northern Ireland are legally responsible for deciding if a person is medically unfit to drive. This means they need to know if a person holding a driving licence has a condition or is undergoing treatment that may now, or in the future, affect their safety as a driver.

4. The driver is legally responsible for telling the DVLA or DVA about any such condition or treatment. Doctors should therefore alert patients to conditions and treatments that might affect their ability to drive and remind them of their duty to tell the appropriate agency. Doctors may, however, need to make a decision about whether to disclose relevant information without consent to the DVLA or DVA in the public interest if a patient is unfit to drive but continues to do so’.

28. This guidance clearly says a patient or medical professional must tell DVLA about any issues a patient has that may affect their ability to drive. In line with this, the GP explained Mr J’s and the Practice’s duty to make sure DVLA was told so.

29. Mr J told us what happened may have been a rush of blood to the head, rather than anything more serious.

30. DVLA standards apply here. For neurological disorders (affecting the nervous system) these standards say that after an unexplained syncope (fainting or passing out), including syncope without reliable prodrome (a blackout or loss of consciousness without any warning signs) while standing or sitting, an individual ‘must not drive and must notify DVLA’. It also says, ‘The diagnosis may apply only after appropriate neurological and/or cardiological opinion and investigations have detected no abnormality’. For a class 2 driver it says, ‘If no cause has been identified, the licence will be refused or revoked for 12 months’.

31. We accept Mr J’s concerns about the cause of his loss of consciousness. We understand his unhappiness and are sorry for any distress he experienced. We have not seen any signs of failings when the Practice told Mr J he needed to tell DVLA about what happened.

DVLA medical questionnaire

32. The Practice admitted it had not kept a copy. It explained staff had not scanned it before they sent it and it only had the blank original on file. It apologised for its error but advised Mr J could get a copy directly from DVLA himself. It also added that the GP had discussed the report with Mr J before they sent it to the DVLA, and Mr J had agreed to the contents.

33. The Practice explained the GP had ‘only ticked the boxes and entered answers relevant to Mr J’s clinical case’. It said it was ‘a very straightforward, factual form, without any option for opinions or recommendations’.

34. GMC guidance says: ‘11. If you agree to prepare a report or complete or sign a document to assist the DVLA’s or the DVA’s assessment of a patient’s fitness to drive, you should do so without unreasonable delay’.

35. There is no specific DVLA or GMC guidance on whether a Practice must keep a copy of the information. Our Principles of Good Administration say organisations should create and keep reliable records as evidence of their activities. Because of this, we think that not keeping a copy was a mistake.

36. We looked at whether this stopped Mr J from being able to appeal the decision to suspend his licence.

37. DVLA standards cover what happens when it gets sent this information. It explains it is unable to make a licensing decision until it has considered information from the licence holder (Mr J) and healthcare professionals.

38. It also highlights a patient can request copies of any medical documents held by DVLA.

39. Mr J told us there was a timescale for appealing the decision. He said DVLA would not have been able to give him a copy in time for him to meet the deadline. This is a complaint about DVLA’s processes, not the Practice.

40. We note Mr J had to ask DVLA because the Practice had not kept a copy. But, it is reasonable to say he could have begun his appeal without this one piece of evidence. This is because the Practice explained he was aware of the information the GP had included in it.

41. We recognise this was a distressing time for Mr J. He has clearly explained how difficult things have been. We cannot say the Practice not keeping a copy stopped him from appealing to DVLA.

The cardiology report

42. We then looked at Mr J’s complaint that the Practice did not send the cardiology report to DVLA at the same time.

43. He suggests as the report confirmed he had no issues, if the Practice had sent it at the same time as the medical questionnaire, DVLA would not have suspended his licence.

44. The Practice got a copy of the cardiology report the day after it sent information to DVLA. It sent Mr J a copy but has confirmed it did not send a copy to DVLA. DVLA standards say:

‘Once DVLA is notified of a medical condition and obtains consent, it will make medical enquiries as required. DVLA is unable to make a licensing decision until all the relevant medical information is available and has been considered’.

‘DVLA’s medical enquiries procedure is generally a 2-stage process:

1. Information on the medical condition is sought from the licence holder or applicant, either by paper questionnaire or online 2. Information is sought from relevant healthcare professionals, either by questionnaire or provision of medical notes’.

45. There is nothing in the guidance to say the Practice should have sent the cardiology report to DVLA. DVLA standards say DVLA gets the information it needs. There is no evidence it asked the Practice for a copy of the cardiology report. The Practice told us it would have sent it if DVLA had asked for it.

46. As DVLA did not ask for the report, we do not think the Practice did anything wrong.

Removal from the patient list

47. In its 14 December letter, the Practice explained it had removed Mr J from its patient list because the NHS has a zero-tolerance policy on abusive and threatening behaviour towards its staff.

48. The Practice explained its decision was because of an incident at the Practice earlier that day. It said ‘the staff felt intimidated and threatened by your behaviour. You were shouting loudly…and swearing…you had clearly lost control…You were asked to leave and you refused and we were forced to call the police’.

49. It added that Mr J had made several phone calls where he had shouted ‘loudly and aggressively’ at staff.

50. It also said he had told staff they had made him feel like he may ‘come and drive a car into the surgery’.

51. The Practice also said Mr J left but threatened to return with a sledgehammer. It called the police, who visited Mr J at his home address and told him he must not visit the Practice again.

52. Mr J does not deny that any of this happened. He said he had ‘a long angry rant at the doctor, which I was entitled to’ and confirms he did threaten to drive a car into the surgery.

53. NHS England guidance on ‘Patient removals’ says:

‘An immediate removal can only be requested when an incident involving the patient has been reported to the police by your practice’.

54. The Practice’s own policy for removing patients says:

‘Removing a patient from our medical register other than for routine reasons is a rare event and is only undertaken after serious consideration and the agreement of the partners’.

‘Special reasons for deduction include:

• acts or threats of violence towards staff (in breach of our and the NHS Zero Tolerance Policy) • persistent abuse of staff or unreasonable misuse of practice services, despite warnings • irretrievable breakdown in relations’.

55. It also adds, ‘Where a patient acts or threatens violence, an immediate deduction may be necessary with the involvement of the police’.

56. It says, ‘We shall not remove a patient simply because they make a complaint, however, if the complaint is personally abusive, vexatious or repetitive and without foundation, it may demonstrate a breakdown in relations sufficient to warrant a warning and possible removal’.

57. There is no evidence it removed him because of his complaint against the Practice.

58. We think the Practice acted in line with guidance when it removed Mr J as a patient.

59. We do not underestimate how this situation affected Mr J. For the reasons we have explained, we will not be taking any further action. We hope we have explained our decision clearly.

1. We have carefully considered Mr J’s complaint about a GP practice in the Brent area (the Practice).

2. We recognise losing his driving licence has been an upsetting and stressful time for him.

3. For most of the complaint we have not seen any sign that the Practice did anything wrong.

4. We do think the Practice should have kept a copy of the questionnaire it sent to the Driver and Vehicle Licensing Agency (DVLA). But, we cannot say this stopped Mr J from appealing to DVLA about its decision to suspend his driving licence.

5. We explain this in more detail below.