Dr Sarah Jarvis, MBE
Author: Dr Sarah Jarvis, MBE, General Practitioner (GP)

Sarah is the Clinical Director of the Patient Platform, an active medical writer, broadcaster, and is the resident doctor for BBC Radio 2.

Originally posted: 1st Apr 2021

In the last 20 years the number of global flights has been increasing steadily, reaching 38.9 million in 2019, with 4.4 billion people taking air trips in 2018. In 2020, courtesy of the COVID-19 pandemic, the number of flights dropped to 16.4 million.

Lockdown travel

Under UK lockdown restrictions, you're only allowed to travel for very limited permitted reasons, such as work, medical or compassionate grounds. That means that currently, you need to complete a travel declaration form, if you've travelling from England, declaring the reason you're travelling.  It's recommended in most cases that you also have supporting evidence, such as a letter from your employer or a professional ID card.

Some people travelling abroad from England are exempt from completing a travel declaration form because of their profession. Different rules apply in relation to international travel from  Northern IrelandScotland and Wales.

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Vaccine certificates

Millions of Brits are desperate for a holiday and waiting to see what regulations they'll need to abide by in order to get away. Several countries such as Greece have already announced plans to allow British tourists to enter the country without self-isolating on arrival if they've been vaccinated against COVID-19, or have had a negative COVID-19 test before travelling.

The details of the vaccine  proof are still being worked out – it's possible that even if no international vaccine passport is agreed, people will be able to use a vaccine certificate – possibly accessed via an NHS patient app such as Patient Access or the NHS App.

Medical Travel Compared Waiting To Board

COVID free

Many airlines and countries require anyone flying into a country with them to show proof of a negative COVID-19 swab test, usually within three days of travel. It's important to check with your airline and the embassy of the country you're planning to visit – regulations vary between countries, and some countries require you to self-isolate for up to 14 days on arrival, even if you have a negative test.

The tests involved are almost invariably PCR swab tests (which need to be sent to a laboratory for processing) rather that the rapid access Lateral Flow tests being used in schools and mass testing programmes. That's because PCR tests are more accurate – but it does mean your window of opportunity is narrow. You'll need to arrange your  test less than three days (depending on country) before you travel, but early enough to get the results. These tests are not available on the NHS – there are many private providers, and charges tend to vary depending on how quickly they guarantee the results.

As travel restrictions ease and people can travel for leisure, it's likely that these requirements will remain in place for some time. Some countries may continue to require a negative PCR test even if you've been vaccinated.

Do I need proof I'm fit to fly if I have a medical condition?

If you have a health condition, you’ll want to ensure that you’re fit to fly before travelling abroad.

While you might feel well enough within yourself to tackle the journey, it’s always worth checking-in with your doctor so that they can get a better understanding of your condition before you commit to flying. 

However, beyond a routine chat with your doctor, you might find that there are circumstances where you might need an official fit to fly certificate.

General restrictions on flying

In most cases, airlines will request medical clearance for conditions that are deemed unstable. 

However, air travel is normally not advised in the following cases (although please bear in mind this list is far from exhaustive and you should consult your doctor if you think you could face restrictions for your condition): 

  • angina
  • any active infectious disease
  • decompression sickness after diving
  • increased intracranial pressure (due to bleeding, injury or infection)
  • sinus infections
  • a recent heart attack
  • recent stroke
  • recent abdominal trauma
  • recent gastrointestinal surgery
  • recent brain surgery
  • a recent eye operation
  • severe chronic respiratory disease
  • unresolved pneumothorax (collapsed lung)
  • sickle cell anaemia if there is a significant risk of a sickle 'crisis'

It’s also not advised for infants less than two days old to travel, or women past their 36th week of pregnancy.

When do you need a fit to fly certificate?

A fit to fly certificate is needed to be granted medical clearance by your airline. 

If your condition is stable, it’s very unlikely that you will be asked for medical clearance - but a fit to fly certificate may still be required if: 

  • You’ve recently been discharged from hospital
  • You’re in recovery from an operation
  • You’re more than 28 weeks pregnant
  • You’re actually travelling for medical reasons (i.e. you’re going for some treatment)

Of course, whether you need a fit to fly certificate is at the discretion of your chosen airline, so you should always carefully check their individual guidelines to find out their specific requirements. 

One of the major issues in relation to fitness to fly is the fact that oxygen pressure in a plane is lower than on the ground. That means conditions affecting your heart and lungs, which can reduce your body's ability to carry oxygen round your body, can lead to new or worsening symptoms during flight. In some situations, you may be able to fly if you carry oxygen with you onto the plane – speak to your doctor about arranging this if needed.

As far as individual conditions are concerned, here is a summary of different scenarios where a fit to fly certificate might be required by your airline:

Scenario Flight restrictions
Flying when pregnant Most airlines require a fit to fly certificate after 28 weeks. Most airlines do not allow air travel after 36 weeks (or 32 weeks for multiple pregnancies and some long haul trips).
Flying while recovering from surgery Varies based on severity of the surgery. Contact your airline and your GP about establishing whether you’re fit to fly.
Flying with a heart condition According to the British Cardiovascular Society guidelines, most people with a heart condition can fly safely, but this varies based on severity of condition. Contact your airline and your GP or specialist about establishing whether you’re fit to fly.
Flying with angina Provided symptoms are under control by medication, angina should not be a problem on board an aircraft. However, if you get chest pain while at rest (so-called unstable angina), you may not be able to fly. Contact your airline and your GP about establishing whether you’re fit to fly.
Flying after a heart attack You may be able to travel after 7 to 10 days, provided there are no complications. Always check with your specialist before booking a flight.
Flying after heart failure Provided symptoms are under control, heart failure should not be a problem in flight. However, if you have chest pain while at rest you may not be able to fly. Contact your airline and your GP about establishing whether you’re fit to fly.
Flying with a pacemaker Should not cause problems for travelling by air. However, pacemakers can sometimes set off airport security alarms so be prepared with a letter from your doctor.
Flying after heart surgery Advisable not to fly for at least 10-14 days after bypass grafting or other heart or chest surgery and until you are able to manage normal day-to-day activities. However, if you've had an angioplasty (or other procedure which doesn't involve open surgery) you may be fit to fly from 3 days after the procedure, as long as your specialist gives the okay.
Flying with high blood pressure High blood pressure should not be affected by air travel, but it is advisable to only travel when your blood pressure is controlled. Find out more from our article on travelling with high blood pressure.
Flying with asthma Those with asthma should not have issues with flying, though it is advisable to always carry any medication such as an inhaler in your hand luggage. You can find out more about travelling with asthma from our article.
Flying with a broken bone Because of the risk of swelling inside a cast, many airlines choose to restrict flying during the first 24-48 hours after a cast has been fitted. If you do decide to travel before that time period has elapsed you can expect the airline to require your cast to be split along the full length to prevent any pressure buildup impacting your circulation. Having a letter containing the date & time the cast was fitted will be helpful.
Flying with diabetes Air travel should not pose significant problems for travellers with well-controlled diabetes. However, it's important to check in advance what other precautions you need to take.
Flying with a disability Most people with mobility problems have found it possible to travel by air, especially with legislation which was passed in 2008. If there are other medical issues you should check with your GP that these are taken into account.

Again, it’s important to keep in mind that requirements will differ across different airlines, it’s highly recommended to check on their individual websites prior to travelling. Also remember that your GP has an important part to play in assessing your condition - so be sure to seek their advice as and when you need it. 

If your airline requires you to provide evidence that you’re fit to fly, this will usually come in the form of a Medical Information Form (MEDIF), of which there are usually two parts (here’s an example). Part 1 is usually filled out by the passenger and Part 2 is filled out by the passenger’s doctor.

How much does it cost to get a fit to fly certificate?

This depends on how much your GP surgery charges - but typically this cost ranges from £20-£40. 

You can find a list of suggested fees from The British Medical Association if you want a more comprehensive idea of the different costs and fees you might expect.

When will my fit to fly certificate expire?

Again, there is no clear cut answer for this. But at the very least, your certificate should indicate that you’re fit to fly at the exact time of your trip. 

So, if you have a letter from months ago - the likelihood is that this won’t be suitable for your airline today. 

If you have a recurring, or more permanent medical issue, it’s probably best advised to get a fit to fly certificate every time you travel - just to be on the safe side.

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