The purpose of this blog post is to explain the process of applying for an aviation medical certificate in the UK and reflect the author’s understanding of the subject. The content is not warranted correct and is not medical or legal advice. If you require medical or legal advice you should consult a suitably qualified practitioner in your country.
Anyone wishing to learn to fly should begin by applying for and obtaining a suitable aviation medical certificate. The medical certificate required depends on the licence sought after. This post explains the process of applying for an aviation medical certificate in the UK.
We restrict our discussions to UK Part-FCL, Part-SFCL, Part-BFCL licences, and Part-MED medicals. The UK has ‘national’ licences (e.g. for microlights) for which different requirements apply.
What medical do you need?
Generally, a pilot’s licence is not valid without a valid medical certificate. The medical certificate you need depends on the licence that you are applying for. The CAA produces a summary of the requirements here. Basically:
- A class 1 medical is required for all professional flying licences (CPL, MPL, ATPL).
- A class 2 medical is the minimum required for a PPL. If instrument privileges are to be added to the PPL, additional tests must be carried out (audiogram to class 1 standard).
- A LAPL medical certificate is required for the light aircraft pilot licence (LAPL), sailplane pilot licence (SPL), and balloon pilot licence (BPL), although SPL and BPL holders engaging in commercial operations require a class 2 medical.
The above are the minimum requirements for the issuance of the licence. Different requirements may apply once you have a licence – as discussed below.
A higher medical certificate automatically confers the privileges of the lower classes. For example, a class 1 medical certificate includes class 2 and LAPL medical privileges. The expiry dates of each class are separate and all printed on the certificate itself, so an expired class 1 certificate may continue confer class 2 privileges to a later date.
ICAO Compliance
You will need to consider whether you want to establish ICAO compliance in your licence and medical combination. Establishing ICAO compliance allows you to exercise the privileges of your licence in another ICAO member state, in a UK-registered aircraft and subject to additional local regulations. A Part-FCL professional licence and a Part-MED class 1 medical certificate combination is automatically ICAO compliant. The choices are primarily faced by private pilots.
- Pilots who hold a LAPL cannot establish ICAO compliance because the LAPL is a sub-ICAO licence. Therefore, there is no additional benefit to be gained by applying for a higher medical certificate.
- Pilots who hold a PPL, SPL, and BPL require a class 2 medical to be ICAO compliant, i.e. to be able to fly in other countries. This is particularly an issue for SPL and BPL holders because a class 2 medical is NOT required just to obtain the licence.
- Pilots who hold a PPL, SPL, and BPL who are NOT required to be ICAO compliant may not need a class 2 medical or even a LAPL medical. Once the licence is held, a pilot medical declaration (PMD) is sufficient to fly UK-registered aircraft in the UK airspace. If flying an aeroplane, the PMD restricts you to LAPL privileges, e.g. under 2000 kg MTOW and no instrument (IR or IR(R)) privileges.
When to get a medical
The best advice is to get the appropriate medical before you start training or doing anything else. If you are training for a commercial licence, most, if not all, flying schools require that you have a class 1 medical before letting you enrol. This is for good reasons. If you need to apply for a medical certificate halfway through the training course, at best it would cause some delay, but there is also the undesirable possibility that you are assessed as unfit and unable to continue your training, so all the investment goes to waste. The BALPA advises aspiring commercial pilots here.
The same advice can be given to pilots training for recreational licences for the same reasons.
Once a medical is held, there is a cost to maintain the medical – visiting an aeromedical examiner (AME) regularly for revalidations, for example. This gives an incentive to delay obtaining a medical or to start on a lower medical and only upgrade when the higher medical is needed. Pilots who do this run the risk of being assessed as unfit after significant financial outlay.
Application process
Generally speaking, the application for a medical certificate is done in three steps which are:
- CELLMA application.
- Medical assessment by an aeromedical centre (AeMC) for class 1 medicals, or an aeromedical examiner (AME) for class 2 medicals.
- Further referrals, if required.
CELLMA application
This is the first step in applying for a medical certificate. CELLMA is an online system that the CAA uses to manage medicals, and it replaces all the previous paper-based application forms. You need to register to use CELLMA, make an application there (which is equivalent to filling out a paper application form in the old days), and pay a small application fee (around £16).
To register to use CELLMA, first register an account for the CAA customer portal. Instructions are given here. The account registration takes at least 10 working days to be processed.
Once you have an account for the CAA customer portal, sign in. On the landing page, see if you can use the service ‘Medical’. If you are unable to use it, you need to apply to use it by following the appropriate link and instructions.
Once you can enter CELLMA, fill in a form to apply for the appropriate medical certificate. This is the digital equivalent of the old paper form, which can be found here. The information required is broadly the same. After you submit the form and pay the fees, the CELLMA application process is completed.
If you book an appointment with an AME or an AeMC, you will be required to have completed the CELLMA application before the appointment. If you have not done this, they will typically say they cannot perform the examination and no refund will be given. Some practitioners can fill in the application form for you during the appointment if you didn’t do it, for a fee, but only if you are properly set up on CELLMA already.
Medical assessment
Where you go for a medical assessment depends on the medical applied for. For an initial class 1 medical, you need to go to an AeMC. For an initial class 2 medical, go to an AME. For an initial LAPL medical, go to your GP.
Some of the AeMCs in the UK are Heathrow Medical, Centreline Aviation Medical Services, and Aeromedical Consulting UK (Birmingham).
The choices for an AME are much more numerous, use the CAA’s find an AME service. Your local flying school or flying club should be able to advise as well.
Ensure that you book the right type of appointment as they are very expensive (around £800 for a class 1 initial, and around £200 for a class 2 initial). Contact the practice to check if you are unsure what to book.
The CAA produces detailed information on what to expect at a medical examination.
The definitive medical rules are in Part-MED.
Some of the noteworthy points are:
- You will need to obtain all medical records held of you by your GP who will give you a printout upon reasonable request: just say you need them for an aviation medical.
- If you have any past or current medical condition, be sure to obtain and bring all specialist reports.
- If you wear glasses, you would need to bring an up-to-date (within 12 months) prescription as well as the glasses themselves. Ensure the prescription has your name and address on it.
- If you are currently on any medication, bring them with you alongside all the relevant prescriptions.
- The better prepared you are, the fewer surprises or potential causes for delay. Bear in mind that all AMEs and AeMCs charge an hourly fee for administrative casework, so doing as much casework beforehand as you can for them could save money.
- Be sure to bring your original passport as for many practitioners this is the only acceptable form of identification.
- 24 hours before your medical appointment, do not ingest any alcohol or caffeine, but stay well hydrated ahead of the medical as you will need to provide a urine sample.
- If you are worried that you will have a marginal blood pressure reading, monitor your blood pressure at home for a week or take an 24-hour ambulatory BP monitoring, and try to book a medical appointment at a time when your BP is lower.
- If you have ‘whitecoat hypertension’ which is high blood pressure whenever you see a doctor, bring your at-home readings. While your home readings are not acceptable by the CAA, they can be used to convince your AME that you may be suffering from whitecoat hypertension so they can help you relax and repeat the measurements as necessary.
Eyesight
Most people do not understand the eyesight requirements for being a pilot, which are complex. The definitive rules are given in MED.B.070 Visual System. To summarise, wearing glasses does not, in general, make one unfit, but some other conditions and laser eye surgery might.
If you wear glasses, the CAA has a spreadsheet tool to check whether your prescription is acceptable for a medical and if any additional requirements will apply. It can be downloaded here. If you wish, you can drill into the formula in the cells to understand what the rules are. If the spreadsheet says ‘complete additional tests’ it would also tell you what the additional tests are, and the AeMC can usually perform the additional tests for you. After the additional tests have been completed, the results will be sent to an external specialist consultant for review. This consultant does have the right to request to see you if they deem it necessary, and the AeMC will tell you what to do in that case.
If the spreadsheet says ‘refer to CAA medical assessor’, that means a CAA medical assessor must decide on your medical fitness: see below.
Wearing glasses will result in limitations being endorsed on your medical. The most common one is VDL: valid only with correction for defective distant vision. Practically, this means when you fly you must wear your glasses and keep a spare pair handy. Provided that you comply with the requirements this does not limit your flying in any further ways. A full list of possible limitations is found in MED.B.001.
ECG
During an initial class 1 and class 2 medical, you will undergo an ECG test. This involves the AME using a CAA-approved ECG machine, loaded with an approved interpretation software, to measure and interpret your ECG. When the software finishes interpreting your ECG it will print out one or more computer statements. This document lists the acceptable computer statements. If all the computer statements are acceptable, the AME will mark your ECG as an acceptable computer read and you will pass the test. If one or more statements are not acceptable, the ECG would require overreading by a consultant cardiologist. The AME/AeMC would have consultant cardiologists that they use and they would arrange the overread on your behalf. You will need to pay a fee for this (ranging from £50 to £100).
The consultant cardiologist who overreads your ECG would complete an ECG reporting form (Form 108). The possible outcomes are given on the form. The consultant cardiologist can recommend additional investigations before an assessment can be made, the common options are listed on the form (all four would cost just under £1,000). The NHS is unlikely to cater for these investigations and you will need to go private. The AME/AeMC can put you in touch with specialists who perform these investigations. Once the investigations are completed, reports will be sent back to the AME/AeMC.
Referrals and primary assessment of medical fitness
After a medical examination, you may need to be referred to other specialists for further reports. The most common cause for referrals is an ECG abnormality discussed above.
In simple cases, the AME examining you is allowed to decide on your medical fitness, possibly in consultation with a CAA medical assessor. In this case, you will get your medical certificate on the day if no referrals are required, or get it later in case of referrals to allow time for the AME to gather and consider the specialist reports.
In complex cases, the AME examining you is not allowed to decide on your medical fitness. Instead, a CAA medical assessor must decide on your fitness, and your AME/AeMC must refer the case to them. A CAA medical assessor is a highly experienced AME who works for the CAA medical department. There are a lot of conditions known as ‘mandatory referrals’, one or more of which require your case to be referred to a CAA medical assessor. A common one is high refraction in your eyesight. In this case, expect a delay of at least 10 working days from the day your case is referred to the CAA. You will receive a decision letter by email and, if fit, the medical certificate will follow in the post.
Appeals
If you are assessed as unfit, or you do not agree with some limitations that have been endorsed on your medical certificate, you can appeal CAA’s decision. This is a complex topic and you should get specialist advice. The CAA’s guidance on the appeal process is here.
Useful resources
Medical forms available for download (CAA link, contains most resources above)
SpecCalc spreadsheet tool (most recent copy retained on this site in case CAA link breaks)