A TfL medical is the health check that London taxi and private hire (PCO) drivers need to show they are fit to drive passengers. Transport for London (TfL) measures fitness against the DVLA Group 2 medical standards, the same standards used for bus and lorry drivers. You usually need a medical when you first apply and at certain points when you renew, and some drivers with heart conditions may also need an ECG or exercise test.
What is a TfL medical?
To hold a London taxi or private hire driver licence, you must be medically fit to drive professionally. TfL asks for this to be confirmed on its medical declaration form (TPH/204), completed by a registered doctor. TfL's guidance says the examining doctor should have access to your full medical records, which is why many drivers use their GP, and the doctor must carry out a physical examination in person.
The medical covers your general health, eyesight and any conditions that could affect safe driving, such as heart problems, diabetes, epilepsy, sleep problems, mental health conditions or alcohol and drug misuse.
What are the DVLA Group 2 medical standards?
The DVLA has two sets of medical standards. Group 1 applies to ordinary car and motorcycle licences. Group 2 applies to buses and lorries and is stricter, because of the size of the vehicles and the long hours professional drivers spend at the wheel.
For heart health, Group 2 rules are more cautious about conditions such as:
- angina and heart attacks (acute coronary syndrome)
- coronary stents and heart bypass surgery
- heart rhythm problems and pacemakers
- heart failure and heart muscle conditions
- high blood pressure
The full rules are in the DVLA's guidance on cardiovascular disorders and fitness to drive, written for medical professionals.
When do London drivers need a medical?
The exact timing depends on your licence type, your age and your medical history, and TfL can update its rules. In general:
- New applicants usually need a medical as part of their application, unless an exemption applies (for example, people who already hold a DVLA Group 2 licence).
- Renewing drivers may need a medical at renewal. For both taxi and private hire drivers, TfL says existing licensees over the age of 45 must have a medical if their last one was more than three years ago, or if an age-related medical is due.
- Older drivers may be asked for age-related medicals to confirm they remain fit to drive.
- Any driver can be asked for further medical information if their health changes or TfL needs more information to decide on fitness.
Taxi (black cab) and private hire licences have separate application processes, so always check the latest guidance on the TfL taxi and private hire licensing pages before you book anything.
Where does heart testing fit in?
Many drivers do not need extra heart tests for their TfL medical. However, the examining doctor, TfL or the DVLA may ask for more information if you have, or have had, a heart condition. This might include:
- a resting 12-lead ECG to check your heart rhythm
- an exercise ECG (treadmill test) to see how your heart copes with effort
- an echocardiogram (heart ultrasound) to measure how well your heart pumps (the ejection fraction)
- blood pressure readings (the TfL form asks for a current reading)
If you are unsure which test fits your situation, our guide to ECG vs echocardiogram explains the differences.
When might an exercise test be required?
Under the DVLA Group 2 standards, you must stop driving and tell the DVLA after certain heart conditions or treatments, and an exercise or other functional test is often needed before you can be relicensed. Examples include:
| Situation | What the Group 2 rules generally involve |
|---|---|
| Angina | No angina for at least 6 weeks and meeting exercise or functional test requirements |
| Heart attack (acute coronary syndrome) | At least 6 weeks off driving, heart pumping function (ejection fraction) of at least 40% and meeting test requirements |
| Coronary stent (planned) | At least 6 weeks off driving, ejection fraction of at least 40% and meeting test requirements |
| Heart bypass surgery | At least 3 months off driving, ejection fraction of at least 40% and meeting test requirements at least 3 months after the operation |
The DVLA's standard exercise test is a treadmill test using the Bruce protocol, with an exercise bike test as an alternative for people who cannot use a treadmill. In general terms, you need to complete three stages (9 minutes) of the Bruce protocol without signs such as angina, fainting, a fall in systolic blood pressure of 20 mmHg or more, a rhythm problem that needs treatment or stops the test, or ECG changes suggesting the heart is short of blood. The DVLA does not require anti-angina medicines to be stopped before the test. Our guide to what to expect during an exercise ECG explains how the test feels.
Exact time periods and pass criteria are set by the DVLA and can change. Your clinician will advise on what applies to you.
Can high blood pressure affect your licence?
Yes. Under Group 2 rules, you must stop driving and tell the DVLA if your resting blood pressure is consistently 180 mmHg systolic or higher and/or 100 mmHg diastolic or higher. You may be relicensed once it is controlled, provided treatment does not cause side effects that affect safe driving. Our guide to understanding your blood pressure numbers may help.
How to prepare for your TfL medical
- Download the latest TfL medical form and read the instructions carefully.
- Bring a list of your medicines and details of any hospital treatment.
- Take your glasses or contact lenses if you wear them for driving.
- If you have a heart condition, bring any recent ECG, exercise test, echo or clinic letters.
- Be honest. TfL can refuse or revoke a licence if information on the form is found to be false, and leaving out a condition can put passengers at risk.
If you have chest pain, collapse or severe breathlessness at any time, call 999. For worrying symptoms, speak to your GP or NHS 111, and do not drive until you have been checked.
Frequently asked questions
Is the TfL medical the same as a DVLA Group 2 medical?
They are closely linked. TfL uses the DVLA Group 2 standards to judge fitness, but it has its own form and process for London taxi and private hire drivers.
Do all drivers need an ECG for a TfL medical?
No. Heart tests are usually only requested if you have symptoms, a known heart condition, or the examining doctor or licensing authority asks for more information.
Can I still drive a taxi or private hire vehicle after a heart attack?
Many people can return to professional driving, but you will need to stop for at least 6 weeks, tell the DVLA and meet the Group 2 requirements, which usually include an exercise or other functional test. Your cardiologist and the DVLA will guide you.
Who can fill in the TfL medical form?
TfL says a registered doctor with access to your full medical records, typically your GP, should complete it after examining you in person.
Where can I find the official rules?
Check TfL's licensing guidance and the DVLA's guidance on gov.uk, as requirements can change.
Cardiac testing for your TfL medical at The Heart Clinic
We provide cardiac tests that can support your TfL medical, such as a resting ECG with Consultant Cardiologist review, with no GP referral needed and a written report usually within 24 working hours. The TPH/204 form itself must still be completed by a doctor with access to your full medical records. Exercise ECG testing is coming soon to our new Luton clinic. See our TfL medical page for details, or contact us to ask which test you need.