Pilot Medicals

Without any consultation and no relevant supporting data, the CAA Chief Medical officer (CMO) has indicated to AMEs that anyone over 60 and taking blood pressure medication, even though they have been on approved medication with a stable BP for some time, should take a stress ECG test and have a clear cardiology report before issue or renewal of a medical certificate. It is also understood that the CMO has set a 10% risk of a disabling event within a year as a trigger for further investigation.

AOPA opposes this blanket requirement unless substantiated with significant evidence of there being an issue. it is AOPA's position that a Class 2 Medical should not be any more stringent than ICAO standards..

AOPA believes that the additional cost of extended tests will drive many more Pilots to making a PMD, using the lower DVLA standards, and therefore taking themselves out of any regime that requires a medical assessment. This is self-defeating for the CMO's policy.  AOPA met informally with the CAA CMO in June 2025 as a starting point for a campaign to redress what we see as a disproportionate change to medical requirements.

Pilot Medical Declaration (PMD)

AOPA supports the option for Pilots to make a PMD where they meet the medical conditions set and any restrictions on licence privileges. For the current CAA Review of the PMD Consultation, we support the current system, but with consideration of the following variations:

• Currently the only student pilots who may fly solo using a PMD are NPPL students flying non-Part 21 aircraft if they meet the ‘up to 5700kg’ criteria. We strongly recommend that this should be extended to all NPPL / LAPL students flying non-Part 21 or Part 21 aircraft who meet the ‘up to 2000kg’ criteria.
• There needs to be a note on the PMD declaration form stating that if the applicant has been declared unfit for a Part-MED medical then the CAA may require further information from the applicant before the declaration is accepted. We understand that this has been happening, so it shoud be made clear to anyone making a declaration.
  

We do not believe it to be fair that there is no independent process to appeal medical decisions made by the CAA and will press for a solution for this.

UK AAIB Fatal Accident Reports

UK AAIB fatal accident reports since 2004 include just one where cardiac failure directly caused the accident. This 2019 accident involved a 64 year old pilot with a British Gliding Association Gliding Certificate and a medical declaration signed by his GP so would not have been required to take any ecg test. Therefore the CMO requirement would not have averted this case has it been in force at the time.

There was a 2022 incident where a 57 year old CPL with a Class 1 medical suffered an in-flight acute cardiac failure. The AAIB report included that expert reports indicated the current medical assessments carried out for flight crew manage the risk to an acceptable level. Additonally, the CAA reported that they continually review their cardiac guidance in light of the latest research. No tests or assessment can give a 100% reliable detection of cardiac issues and any additional tests or assessment presents a risk to the individual of potentially unnecessary loss of licence. A balance needs to be struck between minimising the risk to flight safety and providing fair and reasonable medical assessment of individuals. The rarity of accidents cause by cardiac events in flight suggests this balance is currently about right, and this is continuously being reviewed by the CAA medical department.

There have been five other fatal accidents, between 2009 and 2016, where a cardiac event could not be ruled out. There have been none to date since 2022. 

AOPA ECG Stress Test Reports

Reports submitted to AOPA to date indicate nearly 90% of pilots tested have passed. Of those who failed, around 50% retained their medical after further tests.

The average cost of a test is £675, with a median cost of £517.

This data suggests clearly that the tests, based on 60 or over with controlled hypertension and a statistical risk based on QRISK3 alone, is not proportional to the risk and pilots are unnecessarily being required to undergo a stress ecg test at significant cost.

AOPA will be campaigning to restore proportionality to medical requirements.

Please do continue to report your ecg stress test results.

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