A GP's Guide to Referring for an OT Driving Assessment in NSW
This article is written for GPs and other medical practitioners who find themselves needing to make a decision about a patient's fitness to drive. It covers when to refer, how to complete the Transport for NSW Fitness to Drive form, and how the OT driving assessment fits into the process.
The GP's role in fitness to drive
In NSW, GPs and other treating doctors are central to the fitness-to-drive process. Under the Austroads Guidelines (the national medical standards for driver licensing), doctors have a responsibility to:
Identify when a patient's condition may affect their driving
Advise the patient about their obligations to report the condition to Transport for NSW
Complete the Transport for NSW Fitness to Drive form when required
Make a clinical judgement about fitness to drive, and refer for further assessment where appropriate
The Austroads Guidelines (Assessing Fitness to Drive) provide condition-specific guidance and are the reference standard for these decisions.
When to consider an OT driving assessment
The Fitness to Drive form requires you to indicate one of three clinical judgements:
The patient meets the medical standards and can continue driving
The patient requires further assessment (usually an OT driving assessment)
The patient does not meet the medical standards and should not drive
The middle option is where the OT driving assessment becomes relevant. You're typically in this situation when:
The condition is likely to affect driving, but you can't be sure without a practical assessment. Driving is a complex functional task, and clinical examination doesn't always reveal how a condition translates to on-road performance. This is particularly common with cognitive conditions (dementia, brain injury, stroke), progressive neurological conditions (Parkinson's, multiple sclerosis), and physical conditions affecting motor control.
The patient has multiple factors that together may affect driving. Individually, mild cognitive changes, some physical limitations, and medication effects might each seem minor. In combination, they may be more significant, and an OT assessment can evaluate the overall impact.
The patient disputes your clinical judgement. In some cases, an independent OT assessment provides a clear, objective basis for decision-making that can resolve disagreement.
A change has occurred. A new diagnosis, a significant progression of existing disease, a new medication, or an incident (a minor crash, a medication side effect) may warrant a reassessment.
The patient is a learner driver with a relevant condition. For patients with intellectual disability, autism spectrum disorder, or other conditions that may affect learning to drive, an OT assessment early in the process can guide the approach and funding pathways.
Common conditions where OT referral is appropriate
Not an exhaustive list, but the most common referral conditions include:
Neurological: stroke, transient ischaemic attack, Parkinson's disease, multiple sclerosis, epilepsy (in some cases), brain tumour, traumatic brain injury, acquired brain injury.
Cognitive: dementia (all types), mild cognitive impairment where driving is unclear.
Psychiatric: stable conditions with driving-relevant medication effects, or where cognitive function may be affected.
Physical: amputation, spinal cord injury, significant musculoskeletal conditions, severe arthritis, post-surgical conditions with lasting impact.
Sensory: significant vision changes (in conjunction with optometry/ophthalmology), vestibular disorders.
Age-related: drivers with multiple age-related conditions, or where the annual 75+ medical review identifies concerns.
The Austroads Guidelines provide specific thresholds for when referral is indicated. For conditions where you're unsure, referring for an OT assessment is almost always the safer option than assuming the patient is fit to drive.
Completing the Transport for NSW Fitness to Drive form
You can find a pdf copy of the Fitness to Drive form here.
Some practical tips:
Be specific about the condition. "Cognitive decline" is less useful than "Mild Alzheimer's dementia, diagnosed [date]."
Document the clinical reasoning. If you're indicating that an OT assessment is needed, the form asks you to state why. A sentence or two is usually sufficient, for example, "Patient has mild cognitive impairment affecting working memory. Driving safety unclear without functional assessment."
Include relevant medications. Particularly medications that may affect driving (sedatives, opioids, anti-epileptics, anti-parkinsonian medications).
Provide a copy to Transport for NSW, the patient and the OT. The form can be submitted digitally via HealthLink, or the patient can take the form into Transport for NSW themselves. The OT will also require a copy of the form to provide clinical context for their assessment and to confirm that medical clearance has been provided for the assessment to take place.
How to refer to Steer Driving
Referrals to Steer Driving can come directly from GPs, specialists, or patients themselves (with the completed Fitness to Drive form).
The referral process:
Step 1: Complete the Transport for NSW Fitness to Drive form.
Step 2: Provide the patient with the form, or send directly to Steer Driving via referral@steerdriving.com.au or steerdriving.com.au/referral.
Step 3: The patient (or you) submits a referral at steerdriving.com.au/referral.
Step 4: Steer Driving contacts the patient to arrange the assessment and confirm funding.
Step 5: The assessment is completed (usually within 2 to 3 weeks for standard referrals, faster for time-sensitive cases).
Step 6: Steer Driving provides a written report to you, Transport for NSW, and the patient.
What you'll receive in the report
The OT report provides:
Clinical context. Patient's relevant medical history, medications, and referring information.
Off-road assessment findings. Results of vision screening, cognitive assessment (including standardised tool scores where relevant), and physical assessment.
On-road observations. Detailed notes on driving performance, including specific examples of behaviours relevant to the referral.
Recommendation. One of the following: fit to drive, fit to drive with conditions (specifying conditions), driving lessons and reassessment recommended, vehicle modifications needed, or not fit to drive.
Supporting reasoning. The clinical basis for the recommendation.
Follow-up. Recommended reassessment intervals for progressive conditions.
The report is clear, clinically detailed, and suitable for both Transport for NSW's decision-making and your clinical records.
What to tell patients before they attend
A few things that help patients prepare:
The purpose. This is a medical assessment of fitness to drive, not a standard driving test. The OT is focused on the effects of the medical condition on driving ability.
The format. 2 to 3 hours total, conducted at home (for mobile services like Steer Driving). Off-road clinical assessment first, then on-road drive.
Who will be there. An OT and a specialist driving instructor. Family members are welcome during the off-road part.
What to bring. Glasses, hearing aids, mobility aids, usual medications, their licence, the Fitness to Drive form, and any recent medical reports.
What happens after. A written report goes to Transport for NSW, the referring doctor, and the patient. Transport for NSW makes the final decision about the licence.
Reassessment timing
For progressive conditions, periodic reassessment is usually appropriate. Generally:
Dementia: At least annually.
Parkinson's disease: Annually, with timing adjusted based on symptom progression and medication changes.
Stable post-stroke or post-brain-injury: Depends on recovery trajectory. Typically 12 months post-initial-assessment, then reviewed.
Stable neurological conditions (MS): Typically annually or per Austroads Guidelines.
The Austroads Guidelines provide condition-specific guidance on review intervals.
A note on referrer-OT communication
The OT driving assessment works best when there's clear communication between the OT and the referrer. Things that help:
Referrer includes context. A brief letter or note explaining why you're referring adds useful context beyond the form.
OT reports back promptly. Reports should be provided within 5 working days of the assessment (usually faster).
Questions are welcome. If you'd like to discuss a case before referring, or want clarification on a report, OTs should be contactable.
If you have questions about a specific patient, or want to discuss whether referral is appropriate, you can contact Steer Driving at referral@steerdriving.com.au or 0494 625 229.
This article was written by Elise Cochran, an AHPRA-registered Occupational Therapist and Transport for NSW-registered driver assessor. Elise is the founder of Steer Driving, a mobile OT driving assessment practice in Sydney.
Frequently Asked Questions
When should a GP refer a patient for an OT driving assessment?
When there's a medical condition that may affect driving but where the impact can't be determined by clinical examination alone. Common triggers include cognitive conditions, progressive neurological conditions, post-stroke or post-brain-injury, and complex multi-factor situations.
What form do I need to complete for a fitness-to-drive referral in NSW?
The Transport for NSW Fitness to Drive form. It asks you to indicate whether the patient meets medical standards, requires further assessment, or does not meet standards.
How long does the OT driving assessment take to arrange and complete?
Standard referrals are typically completed within 2 to 3 weeks. Time-sensitive referrals can usually be expedited. The assessment itself takes 2 to 3 hours, with a written report provided within about 5 working days.
What does the OT driving assessment report include?
Clinical context, off-road assessment findings (vision, cognition, physical function), on-road observations, a clear recommendation (fit to drive, fit with conditions, lessons recommended, modifications needed, or not fit to drive), and supporting clinical reasoning.
Can the GP refer directly, or does the patient need to self-refer?
Either works. A GP can refer directly by providing the completed Fitness to Drive form. Patients can also self-refer once they have the completed form from their GP.
How often should I reassess a patient with a progressive condition?
Generally annually for conditions like dementia and Parkinson's disease, with the Austroads Guidelines providing condition-specific guidance. The OT report will recommend a review interval.