Working together on train driver medical fitness
7 September 2026
We have issued more than 29,000 train driving licences (TDL) since the licensing regime was introduced, with drivers continuing to be medically assessed throughout their careers. This means doctors regularly consider a wide range of medical conditions and treatments, making informed decisions regarding the drivers’ fitness to drive.
To better support them, we, along with the recognised doctors, Department for Transport (DfT) and Rail Safety and Standards Board (RSSB) are working together on a pilot Medical Advisory Panel (MAP), recently established, comprising of medical professionals recognised by the ORR to provide TDL medicals.
The concept for the panel followed the 2023 Post Implementation Review of the Train Driving Licences and Certificates Regulations (TDLCR) 2010 and engagement with our recognised doctors. They told us they wanted more opportunities to share experience and discuss the medical issues they encounter in practice. The panel gives them a structured forum to do that, bringing together experienced ORR-recognised doctors from across the industry.
The panel is advisory only. It will not provide second opinions or overrule another doctor, and responsibility for individual medical decisions remains with the doctor carrying out the assessment.
It will look at how the application process for becoming an ORR-recognised doctor can be improved, as well as developing best-practice guidance on medical issues that regularly arise in train driver assessments, including cardiac conditions, diabetes, sleep apnoea and the use of off-label or unlicensed medicines. The panel’s experience will also be helpful as we work together to consider further reform of TDLCR.
The pilot will run until 31 March 2027. Over that period, we want to see how bringing recognised doctors together in this way can improve consistency, strengthen professional support and help keep railway medical guidance up to date.
We also expect the panel to contribute to our work with DfT and RSSB on future reform of TDLCR, including considering where the regulations could be made less prescriptive while continuing to maintain appropriate safety standards.
The pilot will be assessed against six key areas of work. The panel will report its findings to RSSB, which will bring together the evidence and outputs for stakeholders. ORR, DfT and RSSB will then jointly assess the success of the pilot and consider what should happen next.
