Certificate Requests (Fitness to ... Certificates)

More and more organisations are sending people to their doctors to obtain “a note” certifying that they are fit and well for a wide range of activities. This often represents an attempt by organisations or individuals to absolve themselves of responsibility for any medical problem that might subsequently arise.

As well as being time consuming and usually unnecessary, such certificates may even imply some liability on our part. In line with many other practices, we have therefore decided not to sign such documents unless there is a very good reason to do so. This will be at the discretion of the doctor and will involve a fee.

If a patient requires a formal medical examination prior to an activity, on behalf of a third party, we may, at our discretion, provide this service by arrangement, charged on a private basis.

Fitness to Fly Letters

Airlines may ask patients to provide letters or medical certificates confirming that a person's medical condition is currently stable and that they are “fit to fly.” This often affects pregnant women in particular. This work is not included in the GP NHS contract. GPs are not specially trained in aviation medicine and are not insured to certify whether patients are fit to fly. We also do not have direct access to the antenatal records of our pregnant patients, and are therefore unable to provide this certification.

We understand this may cause inconvenience to some patients; however, our primary responsibility is to the safety and wellbeing of all our patients, and we believe this decision aligns with that responsibility. If your midwife is also unable to provide this service, you may wish to access your records via the NHS App and use this information to request certification via a private provider.

Medication for Flight Anxiety (Diazepam and Similar Drugs)

For the reasons set out below, we no longer provide Diazepam or similar drugs for flight anxiety. Instead, we suggest the aviation-industry-recommended flight anxiety courses linked at the end of this page. Flight anxiety does not fall under the remit of General Medical Services as defined in the GP contract, so we are not obliged to prescribe for it. Patients who still wish to take benzodiazepines for flight anxiety are advised to consult a private GP or travel clinic.

Benzodiazepines, including the well-known Diazepam (also known as “Valium”), were initially hailed as a wonder drug. However, it became increasingly clear that, alongside short-term effects on memory, coordination, concentration and reaction times, they are addictive with long-term use, withdrawal can lead to fits, hallucinations, agitation and confusion, and they carry long-term effects on cognition and balance. Benzodiazepines have also become a widely used drug of abuse since first coming to market. For these reasons, their use has been far more tightly controlled worldwide since the 1980s to 90s, especially in the UK; Diazepam is a Class C/Schedule IV controlled drug in the UK.

People often ask us to prescribe diazepam for fear of flying, or to help with sleep during flights. Diazepam is a sedative - it makes you sleepy and more relaxed - but there are a number of good reasons why prescribing it for this purpose is not recommended:

Prescribing guidance

The British National Formulary states diazepam is contraindicated in treating phobic states, and that the use of benzodiazepines to treat short-term “mild” anxiety is inappropriate. They are only licensed short-term for a crisis in generalised anxiety disorder - in which case a patient would not be fit to fly, and should be seeking proper mental health care and support instead.

NICE guidance

Medication should not be used for mild, self-limiting mental health difficulties. Fear of flying in isolation is not a generalised anxiety disorder.

Emergency response

Plane emergencies are rare, but Diazepam can reduce awareness and reaction times, which could affect a passenger's ability to respond in an emergency requiring evacuation.

Blood clot risk (DVT)

Diazepam-induced sleep is an unnatural, non-REM sleep, meaning you move around far less than in natural sleep. This raises the risk of a blood clot (Deep Vein Thrombosis) in the leg or lungs - a risk that increases further on flights over 4 hours.

Paradoxical reactions

A small number of people experience agitation, aggression or disinhibition rather than sedation, which can create risks to the safety of the patient and other passengers, and potentially lead to trouble with the law - similar to effects seen with alcohol.

Long-term anxiety

A 1997 Stanford University School of Medicine study found evidence that benzodiazepine use can interfere with the body's natural process of gradually reducing anxiety over time, potentially perpetuating or worsening anxiety long-term, especially with repeated use.

Legal status abroad

Diazepam is illegal in a number of countries and may be confiscated, or could lead to difficulties with local police - including on a return or onward leg of a journey.

Drug testing

Diazepam remains in your system for some time; if your work involves random drug testing, this could cause you to fail.

Travel insurance

It's important to declare all medical conditions and medications to your travel insurer - failure to do so risks invalidating your policy.

We also do not provide diazepam prescriptions in other similar situations, for example, for dental procedures or before scans or hospital procedures. Responsibility for prescribing in these circumstances does not sit with your GP; please contact your dentist or the person requesting the scan or procedure to discuss this further, as they may prescribe if felt appropriate.