The Ultimate Guide to UK Pilot Medicals: Class 1, Class 2, LAPL & PMD
- 3 days ago
- 35 min read
So, you’ve decided to learn to fly, congratulations! But if acronyms like Class 2, LAPL, and PMD are already making your head spin, you’re not alone. Navigating pilot medical requirements can be confusing for new student pilots. The good news is that it’s usually not as scary as it sounds.
In this ultimate guide, we’ll break down the four main types of pilot medical clearances, from the simple self-declared Pilot Medical Declaration (PMD) to the top-tier Class 1 Medical needed for airline pilots. We’ll explain who needs which medical, what each involves, how long they last, and common concerns (eyesight, medical conditions, costs, etc.). By the end, you’ll know exactly which medical certificate you need and how to get it. Let’s clear the fog and get you one step closer to the skies!
Contents:
Pilot Medicals at a Glance
Which medical do you need? Here’s an overview of the four types and their typical use cases:
Medical Type | Typical Use (Licence & Privileges) | Who Can Issue? | Validity | Use Abroad? | Approx. Cost |
Pilot Medical Declaration (PMD) | For NPPL or old UK PPL; also usable with LAPL/PPL when flying only within LAPL privileges (UK airspace only, up to three passengers, aircraft not exceeding 2,000 kg, and applicable operating limits) | Self-declared online (pilot fills form) | Until age 70; then renew every 3 years | No (UK airspace only) | Free |
LAPL Medical (Light Aircraft Pilot Licence Medical) | For LAPL licence holders (recreational pilots); can also be used by PPL holders flying only LAPL-level privileges | General Practitioner (GP) or AME (Aeromedical Examiner)1 | 60 months (under age 40); 24 months (age 40 and above) | Limited (historically EASA-recognised in the EU for LAPL flights, but not ICAO compliant) | ~£140 to £1802 |
Class 2 Medical | For PPL (Private Pilot Licence) and NPPL if needed; the standard private pilot medical for worldwide private flying | AME (CAA-certified aviation medical doctor) | 60 months (under 40 years old); 24 months (40 to 49); 12 months (50 plus)3 | Yes (ICAO-compliant for international private flying) | ~£180 to £250 |
Class 1 Medical | For CPL/ATPL (Commercial Pilot Licence, Airline Transport Pilot Licence); required to fly professionally (airlines, charter, instructors*) | AeMC (Aeromedical Centre) for initial; AME for renewals | 12 months normally; 6 months if over 60 (or over 40 when flying single-pilot commercial ops with passengers) | Yes (ICAO-compliant for commercial flying) | ~£600 to £800 (initial); £200 to £300 (renewal) |
1 In practice, most GPs do not perform LAPL medicals, so most pilots go to an AME even for a LAPL Medical.
2 Costs vary; LAPL medicals are usually slightly cheaper than Class 2 since the exam is less extensive.
3 Validity is capped by age: e.g. a Class 2 issued at 39 expires by age 42 (even if 60 months not fully up). Likewise, one issued at 49 expires by 51.
(Instructors: A Flight Instructor must hold at least a Class 2 in the near future, see PMD section for current rules.)
Which Medical Do You Need?
If you’re unsure, use the quick flowchart below to decide which medical certificate fits your flying goals:
The Pilot Medical Declaration (PMD)
The Pilot Medical Declaration (PMD) is the simplest and most accessible way to meet the legal medical requirement for flying, essentially a self-certification of your fitness to fly. Instead of visiting a doctor, you declare online to the Civil Aviation Authority (CAA) that you meet a DVLA Group 1 ordinary car driving licence health standard and that you do not have any of the disqualifying conditions listed on the form. It’s quick (takes minutes to fill out), it’s free, and for many hobby pilots it’s all you need. However, it comes with important limitations and isn’t for everyone.
Who Can Use a PMD?
The PMD is primarily intended for pilots flying on national licences for recreational flying. In practice, this means:
NPPL holders (National Private Pilot Licence, e.g. for microlights or gliders) can use a PMD instead of a Class 2 or LAPL medical.
Holders of old UK Private Pilot’s Licences issued pre-JAR (pre-2000s “UK PPL” under the ANO) can also use a PMD, since those licences are non-ICAO and valid only in the UK anyway.
A PMD can be used with a Part-FCL PPL or a LAPL, but only when the pilot is flying within LAPL privileges (maximum of four persons on board, aircraft not exceeding 2,000 kg MTOM, UK airspace only). For full Part-FCL privileges a Class 1, Class 2 or LAPL medical certificate is required.
In short, the PMD is perfect for local, recreational flying within its specific limits. It is not an internationally recognised medical and does not meet ICAO requirements, so you cannot fly abroad with only a PMD unless the foreign aviation authority has explicitly granted permission (this is rare). Also, you can’t use a PMD for any sort of commercial flying or full instrument rating privileges.
How to Get a PMD:
You simply log into the CAA medical online portal, fill out a form declaring you meet the medical requirements, and submit it. There’s no exam. The declaration remains valid until age 70. After 70, you need to renew it every 3 years (by re-submitting a new declaration). If your health changes such that you no longer meet the requirements, you should withdraw your declaration. Keep in mind that making a false declaration can have legal consequences, you are signing to say you truly believe you’re fit to fly.
Important Limitations and Exclusions:
Not everyone is allowed to use a PMD. The standard you must meet is roughly equivalent to the health standard for a private driver’s licence. If you have certain medical conditions or histories, you must not fly on a self-declaration. You will instead need to be examined by an aviation doctor for a higher-grade medical (LAPL, Class 2, or Class 1 depending on what you plan to do). According to CAA rules, you cannot use a PMD if any of the following apply to you:
Not Fit to Drive: You don’t reasonably meet the medical requirements for a DVLA Group 1 (car) driving licence. (In other words, if your health would bar you from driving a car, it bars you from using a PMD.)
Psychiatric Medications or Illness: You are currently taking medication for any psychiatric illness (for example, medication for depression, anxiety, ADHD, etc.), or you have been diagnosed with serious psychiatric conditions such as bipolar disorder, schizophrenia or another psychotic illness, or a significant personality disorder. These conditions require evaluation by an aviation medical examiner, you cannot self-certify in these cases.
Neurological Issues: You have ever had a seizure, epilepsy, or frequent fainting episodes, or have any neurological condition that could affect consciousness or motor control (for which you take medication). A history of unexplained loss of consciousness falls here too. Such conditions are disqualifying for a PMD.
Heart or Lung Conditions: You have a heart condition that causes symptoms or requires medication. For instance, if you have angina or heart failure that needs medication, that’s not allowed on a PMD. Also if you’ve had major cardiac surgery or interventions (such as a coronary stent, bypass surgery, or pacemaker implantation), you must get at least a Class 2 medical clearance. Similarly, chronic lung disease that causes shortness of breath with mild exertion (e.g. severe COPD) would disqualify you from a self-declaration.
Insulin-Treated Diabetes: If you require insulin to manage diabetes, you cannot fly on a self-declaration. Insulin-dependent diabetics need a formal medical assessment (though well-controlled diabetics can often get a Class 2 with special monitoring requirements).
Substance Abuse: A history of alcohol or drug addiction or misuse will preclude use of a PMD. These cases need evaluation by an AME.
Other Significant Medical Issues: Any serious physical or mental condition that could suddenly impair your ability to safely operate the aircraft. For example, significant mobility impairments or neurological disorders that affect your limbs, uncontrolled thyroid disease, or poor eyesight that doesn’t meet driving standards (uncorrected) would be problematic. Recent major surgery or a newly started medication that could affect cognitive or motor function is also a no-go for self-certification until properly evaluated.
That’s a long list, but in simpler terms: if you are generally healthy and would pass an ordinary driver’s licence health check, you’re likely fine to use the PMD. If you have one of the above conditions, you’ll need to see an aviation doctor for a higher-grade medical instead, it doesn’t necessarily mean you can’t fly at all; it just means you need the oversight of an AME who can assess you properly and perhaps issue a restricted certificate.
Practical Use Cases for PMD:
Many leisure pilots love the PMD because it lowers the barrier to flying. For instance, an older pilot who only flies a small two-seater around the local area with a friend on weekends might opt for a PMD to avoid the hassle and cost of periodic medical exams. Also, during flight training for an NPPL (microlight or simple aircraft licence), you can start flying solo with just a PMD (you do not need a full Class 2 if you’re pursuing an NPPL).
However, and this is critical, if you plan to get a full PPL (the international Private Pilot Licence) under Part-FCL, a PMD will only carry you so far. You can use a PMD up until the point of exercising LAPL privileges as mentioned (UK airspace only). To use the full privileges of a PPL (like flying abroad or at night), you will eventually need at least a Class 2 medical.
Also, note that student pilots going for a PPL or LAPL must have an actual medical certificate (LAPL, Class 2 or 1) before doing their first solo flight. A PMD is not acceptable for solo flight if you are training for a Part-FCL PPL, it’s only acceptable for training towards the NPPL or other national licences.
(In other words, if you are training for a Part-FCL PPL, plan on getting a Class 2 or LAPL medical early.)
Instructors and PMDs:
One area of recent change is in flight instruction. Until now, even some flying instructors have been instructing students while themselves only holding a PMD. However, the CAA has raised concerns about this practice. As of late 2025, they announced an intention to stop allowing flight instruction on a PMD. The plan is to require that instructors hold at least a Class 2 medical certificate to ensure a higher standard of oversight for those responsible for training new pilots. This change is under consultation and likely to come into effect soon. So, if you’re an aspiring instructor or planning to take lessons, be aware that instructors may no longer be permitted to teach on just a self-declaration in the near future. In short: if you aim to become a flight instructor, plan on getting a Class 2 or Class 1 medical. This change will not apply to microlight instructors, who can continue to instruct on a PMD.
Bottom Line (PMD):
The Pilot Medical Declaration is a fantastic route for purely recreational flyers staying within its limits. It’s easy and cost-free. Just make sure you honestly meet the health requirements, it’s about safety for you and others. If you have any doubt about a medical condition, it’s wise to talk to an AME anyway. And remember, if your aviation ambitions grow (bigger planes, trips abroad, advanced ratings), you’ll need to move up to a certified medical at some point. But for Sunday-afternoon local flights in good weather, the PMD is the simplest “license to learn” for your body.
The LAPL Medical
Moving up one step in stringency, we have the LAPL Medical. “LAPL” stands for Light Aircraft Pilot Licence, which is a sub-ICAO licence mainly for recreational flying. Even though the CAA will stop issuing new LAPL(A) licences for aeroplanes from October 2025 (in favour of the national NPPL or full PPL), the LAPL medical certificate remains in use. This medical is sort of a middle ground: it’s an actual medical certificate issued by a doctor, but the standards are a bit less strict than those for the Class 2 (PPL) medical. Think of it as the “light aviation” medical check.
Who Needs a LAPL Medical?
If you hold a LAPL licence (for aeroplanes, helicopters, etc.), you are required to hold at least a LAPL Medical certificate (or you can hold a higher certificate like Class 2 or 1; higher is always acceptable). Since new LAPL(A) licences aren’t being issued after 2025, this mostly applies to existing LAPL holders or those flying LAPL(H) helicopters.
How to Get a LAPL Medical, GP or AME?
One unique aspect of the LAPL medical is that the regulations allow it to be issued by your NHS General Practitioner (GP), not just specialist aviation doctors. The idea (back when EASA created the LAPL) was that since it’s a simpler medical, your family doctor, who knows your history, could sign you off. In reality, however, most GPs decline to perform LAPL medical exams. There are a few reasons:
Many GPs are not familiar with aviation medical standards and don’t feel comfortable signing off a pilot without guidance.
GPs are extremely busy and may not have the appointment time to do even a short aviation exam (which includes an eyesight test, etc.).
There may be issues of liability or lack of CAA portal access.
As a result, the vast majority of LAPL medicals are done by AMEs (Aeromedical Examiners), the same doctors who do Class 2 and Class 1. The exam for a LAPL is slightly less involved than a Class 2, but you’ll likely visit an AME’s office for it. The cost is usually a bit lower than a Class 2 exam (for example, maybe £120 to £180, depending on the clinic).
What the LAPL Medical Exam Involves:
Expect a basic physical check-up and a review of your medical history. The AME (or GP) will go through a questionnaire of your health background. They will test your eyesight (both near and distant vision, with or without correction as needed). They’ll check colour vision at initial issue (Ishihara plates test, same as higher certs; you need to distinguish those coloured dot numbers to pass). There’s a routine hearing test, though for LAPL this might be as simple as a conversational check (if you can hear a normal conversation at 2 meters, you’re fine). They’ll measure your blood pressure, listen to your heart and lungs, and check general things like reflexes. You’ll provide a urine sample (to screen for things like diabetes or kidney issues). Typically, for a LAPL medical, they do not require an ECG or blood tests in a healthy young applicant, those are generally reserved for Class 2 and Class 1, or if you have a particular risk factor that prompts it. In summary, if you’re relatively healthy, the LAPL exam feels like an ordinary check-up with an added focus on vision and hearing.
Validity and Renewal:
A LAPL medical is valid for 5 years (60 months) if you are under age 40. Once you hit your 40th birthday, any new LAPL medical you obtain will be valid for 24 months (2 years) at a time. (So, for example, a 42-year-old pilot’s LAPL medical would expire 24 months after the exam date.) Unlike the Class 2, there’s no further reduction at age 50, it stays at 24-month renewals even into your 50s, 60s, etc., as long as you continue to meet the standards. This “long validity” is one appealing factor of the LAPL medical, fewer doctor visits compared to an annual Class 2 for older pilots. Keep in mind, you can renew a LAPL medical by seeing an AME (or willing GP) within 45 days before it expires, just like other medicals, to keep continuity.
Medical Standards:
The actual medical standards for LAPL are a bit more lenient than Class 2 in certain areas. For instance, the vision standards allow slightly worse uncorrected eyesight, as long as you can be corrected to good vision. Blood pressure cut-offs might be a tad more forgiving. However, don’t underestimate it, you still need to be in reasonably good health. Serious conditions that would fail a Class 2 will likely also fail a LAPL (maybe with a bit more room for case-by-case discretion). One notable difference: If you have had a significant medical issue in the past and were ever declared “unfit” or had a medical certificate revoked, you cannot use a GP for a LAPL medical, you must go to an AME. (The CAA doesn’t want someone bypassing a known issue by shopping for a lenient GP.)
Use Outside the UK:
Prior to Brexit, a LAPL medical was valid across EASA land when flying on an EASA LAPL. Post-Brexit, a UK-issued LAPL medical on a UK licence is really only valid for flying inside UK airspace (and possibly in other countries’ airspace only if they explicitly accept it case-by-case, similar to the PMD situation). Generally, assume UK-only for use, or at least not automatically accepted abroad. If you plan to fly in Europe, better to have a full Class 2 and PPL which are internationally recognised.
LAPL Medical and Aging Pilots:
One interesting facet: because LAPL medicals don’t shorten to every 12 months at older ages, some senior pilots find it easier to keep flying on a LAPL medical than on a Class 2. For example, a 68-year-old PPL holder would need a Class 2 renewed annually, possibly with an ECG each time; whereas if they switch to a LAPL medical, they might only need a check every 2 years. This can be more convenient and less stressful, provided they limit themselves to LAPL privileges.
Bottom Line (LAPL Medical):
The LAPL medical is a great middle option for recreational pilots. It provides an extra level of safety oversight beyond the self-declaration, but with less red-tape than a full Class 2. If you’re a new student pilot aiming just for a basic licence to fly for fun, this could be your go-to. Just remember its limitations, particularly regarding international flying and advanced privileges. And practically speaking, plan to visit an AME for it, since your local GP will likely send you to one anyway.
The Class 2 Medical (The Private Pilot Standard)
For most private pilots around the world, the Class 2 medical certificate is the gold standard. A Class 2 medical is what you need to exercise the privileges of a PPL (Private Pilot Licence) on aircraft that are internationally recognized. It’s the baseline ICAO-compliant medical for non-commercial flying. If you want to fly yourself and friends/family around, potentially venture into other countries’ airspace, fly at night or in the clouds with an instrument rating (as a private pilot), a Class 2 is required.
Even if you’re just a student pilot, if you’re aiming for a PPL, it’s strongly recommended to get your Class 2 medical early, ideally before you solo or at least early in training, to ensure you meet the requirements before spending a lot on lessons.
What to Expect in a Class 2 Medical Examination:
A Class 2 medical must be conducted by a CAA-certified Aeromedical Examiner (AME). These are doctors (often GPs or specialists with aviation medicine training) scattered around the country, you can find one near you via the CAA’s online AME search tool. The initial examination is fairly comprehensive (plan for about an hour appointment). Here’s what typically happens at an Initial Class 2 Medical:
Medical History Review: The doctor will go over your health history form. They’ll discuss any past illnesses, surgeries, medications, family history of significant diseases, etc. It’s important to be honest and upfront; having a past issue doesn’t always disqualify you, but hiding it could cause bigger problems later.
General Physical Exam: The AME will do a head-to-toe basic check. This includes listening to your heart and lungs with a stethoscope, checking your blood pressure and pulse, examining your abdomen, checking the motion of your limbs, and basic neurological checks (reflexes, coordination). They want to ensure you have no uncontrolled medical conditions.
Eyesight Test: Vision is a biggie for pilots. For Class 2, you need to have a certain level of visual acuity, but wearing glasses or contact lenses is absolutely fine as long as your vision is correctable to standard. The doctor will test your distant vision (typically reading a Snellen chart at 6 meters), your near vision (reading small print up close), and possibly intermediate if needed. There are limits on how strong your eyeglass prescription can be, but they are generous: roughly up to +5.0 diopters of long-sightedness or -8.0 diopters or so of short-sightedness might be acceptable if well corrected (Class 2 can be a bit more lenient than Class 1 on this). The AME will also check for colour vision at the initial exam, usually by asking you to identify numbers in the Ishihara colour dot plates. (Don’t stress too much; if you have common red-green colour deficiency, you may not pass this, but you could still get a Class 2 with a daytime-only restriction. More on colour vision in the Worries section.)
Hearing Test: For Class 2, hearing requirements can often be satisfied by a simple conversational test, e.g., the doctor might stand a few meters behind you and whisper or use a quiet voice to see if you can hear them. If you can, you pass. If there’s any doubt (or if you plan to pursue an Instrument Rating requiring radio work in clouds), they might do a pure-tone audiogram (where you wear headphones and press a button when you hear beeps). Note: an audiogram is mandatory if you seek an Instrument Rating: initial IR issue requires a formal hearing test, and for private pilots under 40 it would be rechecked every 5 years, over 40 every 2 years.
Urine Test: You’ll be asked to pee in a cup. They dip a test strip to check for things like sugar (glucose), protein, or blood in your urine. This is primarily to screen for diabetes or kidney issues. Make sure you don’t skip breakfast entirely and then chug a sugary drink, that could cause a false positive for glucose; if you’re healthy, just normal diet and hydration is fine.
Electrocardiogram (ECG): For Class 2, an ECG (heart tracing) is required at your initial exam if you haven’t had one before. They’ll place sticky electrodes on your chest, arms, and legs and record the electrical activity of your heart. It’s painless and quick. The AME is looking for any signs of heart rhythm problems or other issues. If you’re young (under 40) and it’s normal, you won’t need another routine ECG until age 40. After that, Class 2 rules require an ECG at age 40 and then every 2 years after age 50. (If something abnormal shows up, they might ask for more frequent checks or a specialist review.)
Blood Test (Haemoglobin & Cholesterol): It’s not always done for everyone, but some AMEs will do a finger-prick blood test to check your haemoglobin level (to ensure you’re not anemic) and possibly cholesterol, especially if you have risk factors or are older. These are more likely if you’re above 40 or if your family history suggests it. They’re mostly advisory, for your health awareness, unless extremely abnormal.
Lung Function (Spirometry): If you have a history of asthma or smoking, the AME might ask you to do a quick spirometry test, blowing hard into a tube, to measure lung capacity and function. Routine Class 2 initial might not always include it unless indicated, but many do it as a baseline. If you have well-controlled mild asthma, it usually isn’t a showstopper at all, but they want to see that your lungs perform adequately.
Audiogram: (as mentioned above, done if needed or if IR is planned).
Discussion and Advice: If everything checks out, the AME will likely discuss any lifestyle things (if your blood pressure is borderline high, they might advise cutting salt or losing a few kg, for instance, but still pass you). They understand people get nervous (“white coat syndrome” can spike your BP a bit, and AMEs know this and account for it).
If you pass all the required items, the AME will issue your Class 2 Medical Certificate on the spot (often printed from the CAA system). You’re then officially medically fit to fly as a private pilot!
Validity of Class 2:
The validity period depends on your age:
If you’re under 40, a Class 2 is valid for up to 60 months (5 years). However, note, if you got it at age 39, it won’t go a full 5 years, it will expire when you turn 42. So effectively it’s “until age 42 or 5 years, whichever comes first” for the under-40 folks.
If you’re 40 to 49, it’s valid for 24 months (2 years). Similarly, one issued at 48 will expire by 51st birthday, etc.
At 50 and beyond, it’s valid for 12 months (1 year at a time).
These are maximum intervals assuming no new medical issues. Many pilots treat the medical as an annual check-up anyway even in their 40s for peace of mind. Remember, you can renew within 45 days before expiry to extend from the original date; if you let it lapse beyond expiry, you’ll need a slightly more involved renewal exam (but nothing too drastic unless it’s lapsed over 5 years, in which case you basically have to do initial tests again).
Using a Class 2, Privileges:
With a valid Class 2, you can exercise the full privileges of a PPL: flying any aircraft your licence covers (SEP, multi-engine piston, etc.), anywhere in the world (subject to licence permissions), with passengers, by day or night, and even under instrument flight rules (if you have an IR or IMC rating). It is accepted internationally because it meets the ICAO “Class 2” standard. So if you want to fly to France for lunch, your Class 2 medical is fine (and required, a PMD would not cut it abroad). If you only hold an NPPL (national licence) but you have a Class 2, you’re actually exceeding the requirement (NPPL only legally needs a PMD), but some pilots do this if they want the extra reassurance or if they might upgrade to a PPL later.
Cost:
Class 2 medical prices are not fixed by the CAA, each AME sets their fee. Typically, initial Class 2 exams in 2025/2026 range from about £180 to £250. Renewals can be a bit cheaper than initials (maybe £150 to £200) since less testing is needed if nothing changed (e.g., usually no repeat ECG until due by age). It’s worth shopping around: some AMEs in big cities charge more (to cover clinic costs), while others in smaller towns might be more affordable. However, don’t just pick by price, choose someone who is convenient and makes you feel comfortable. A good AME will guide you through the process and help you relax.
If You Fail or Have an Issue:
Most healthy individuals pass the Class 2 with no trouble. If the AME finds something borderline (say, slightly high blood pressure or an abnormal ECG), they might defer issuing your certificate until you get further tests or treatment. Failing the Class 2 outright on first attempt is uncommon; often, it’s a “defer pending more info” situation. If ultimately you can’t meet Class 2 standards, you might still qualify for a LAPL medical or, if not, you’d be limited to a PMD (if even that standard is met, see the earlier PMD section). We’ll cover common medical worries in the next section.
Renewals:
Renewing a Class 2 is usually quicker than the initial. The AME will still update your history and do an exam, but some tests are not repeated every time (for example, ECG only at certain ages as noted, audiogram only if instrument-rated and due). If nothing major changed in your health, it’s often a straightforward process.
Tip for Student Pilots:
It’s wise to get your initial Class 2 early in your training, even before you put too many hours in. Why? Because if there’s an unforeseen issue that could prevent you from getting the medical, you’d want to know before spending thousands on flight lessons. A classic bit of advice: “Don’t invest in an airplane or flight school before you invest in your medical.” Most times it’ll be fine, but for that rare case someone discovers, say, a heart condition, it’s better to find out on a £200 medical exam than after £5,000 of training. Also, having the medical in hand means when it’s time for first solo, it’s one less administrative hurdle.
Bottom Line (Class 2):
The Class 2 medical is your ticket to full private flying with no geographic limits. It’s a thorough check but not an unreasonable one. Many pilots even appreciate the periodic health exam, it can catch issues early. Stay reasonably fit, manage any conditions with your doctor, and you’ll likely keep your Class 2 for decades. If your dream is to fly recreationally and maybe take friends abroad or at night, aim for the Class 2.
The Class 1 Medical (The Commercial Standard)
Finally, we come to the Class 1 Medical, the highest level of medical certification for pilots, required for those who intend to fly commercially (i.e. Airline Transport Pilots, Commercial Pilots, and typically Flight Instructors who operate for hire). This is the one you need if you want to captain an airliner or even co-pilot one. It’s also the most involved examination, especially the initial issuance, often described by pilots as a “full body MOT”. But don’t let that intimidate you, it’s all done to ensure safety when you’ll be responsible for many lives in a high-pressure environment.
Who Needs Class 1?
If you aim to hold a Commercial Pilot Licence (CPL) or an Airline Transport Pilot Licence (ATPL), you must have a valid Class 1 Medical Certificate to exercise those privileges. This includes airline pilots, charter pilots, corporate jet pilots, etc.
Even if you’re just starting as a student but your end goal is an airline career, it’s highly advisable to go for an Initial Class 1 medical early on (even though technically a Class 2 would suffice while you’re training for a PPL). The reason is: you don’t want to spend £10k to £15k on getting a PPL and hour-building, only to discover at the CPL stage that you have a medical issue preventing you from going commercial. Get the Class 1 done upfront to know you’re cleared for that path.
Where to Get a Class 1:
Unlike Class 2 (which any AME can do), an Initial Class 1 Medical must be done at an approved Aeromedical Centre (AeMC). The primary one is the CAA’s own centre at Gatwick Airport. There are also a few other AeMCs (for example, in London, Manchester, etc.) that can do initial Class 1s. When you book, make sure it’s an AeMC if it’s your first time. After you have the initial certificate, renewals can usually be done by local AMEs (you don’t have to trek to Gatwick every year, though some prefer to).
The Initial Class 1 Exam, Buckle Up for a Full Day:
Plan to spend a good chunk of the day at the medical centre. It’s not painful, but it is thorough and can be tiring. Here’s a rundown of what typically happens:
Comprehensive Medical History and Forms: You’ll fill out detailed forms about your medical history, and the doctors will review them with you. If you have any prior conditions, bring medical letters or reports. Honesty is crucial.
Physical Exam: Similar to Class 2 but even more detailed. Several specialists might check you. For instance, a physician will do a full body exam, checking cardiovascular, respiratory, neurological, musculoskeletal systems, etc.
Vision Exam by an Ophthalmologist or Optometrist: The Class 1 initial usually includes a deep eye exam. This can involve an eye specialist measuring your visual acuity, checking your field of vision, depth perception, and eye health. They often administer dilating eye drops to get a good look at your retina and optic nerve, so your pupils go big and your vision gets blurry for a few hours (good to have someone with you or take public transport, as you shouldn’t drive right after). They’ll measure your refractive error (glasses prescription). Class 1 visual standards allow up to +5.0 hyperopia or -6.0 myopia (similar to Class 2 for initial issue), with astigmatism up to 2 diopters, etc., as long as it’s correctable to 6/6 each eye. If your prescription is on the stronger side, you might need to bring a recent optometrist report. They will also do the Ishihara colour test for colour vision, and possibly additional color perception tests if needed (like lantern test) if you don’t pass Ishihara, since an unrestricted Class 1 requires normal colour vision.
Audiometry: You’ll undergo a formal hearing test in a soundproof booth. You put on headphones and press a button when you hear faint tones at various frequencies. This determines if you meet the required hearing levels (not more than 35 dB loss in the speech frequencies, etc.). Even if you think your hearing is fine, they check it objectively.
Blood Tests: Typically, they will take blood (or at least a finger-prick sample) to check your haemoglobin (for anemia), cholesterol level (as a risk factor check), and sometimes other things like blood sugar or liver function as baseline.
ECG (Electrocardiogram): A resting ECG is always done at initial Class 1. Electrodes on your chest record your heart rhythm. If you’re over a certain age (often 40) or have risk factors, they might even do an exercise ECG (treadmill test), but for most young first-timers this isn’t done unless something on the resting ECG is iffy.
Lung Function Test: Spirometry is often included. You’ll blow into a tube forcefully to measure lung capacity and flow. If you have asthma history, they pay attention to this. As long as your asthma is well-controlled and your lungs function decently with an inhaler, you usually pass (might come with a limitation like carry your inhaler when flying).
ENT Exam: Ears, nose, throat are checked. For example, they’ll ensure your eardrums look healthy (important for pressure changes when flying).
Laboratory Urine Test: Similar to Class 2, but possibly done more formally in a lab on-site.
Chest X-Ray: In the past, a chest X-ray was routinely done at initial Class 1. Nowadays, it’s typically done only if medically indicated (for example, if you have a history of lung issues or risk factors like TB exposure). It’s no longer an automatic requirement for every applicant.
Height/Weight and General Fitness: They’ll measure your height and weight to calculate BMI. While there’s no strict BMI cut-off, extremely high BMI might prompt checks for things like sleep apnea. As long as you’re reasonably fit or your high BMI is due to muscle, you should be okay, but you might get advice to manage weight if it’s in obese ranges.
Psychological/Mental Health Evaluation: There isn’t a formal psyche test for every applicant, but the examiner will ask you some questions about mental health history (depression, anxiety, ADHD, etc., anything diagnosed or treated?). They observe your demeanor as well. If you indicate a history of, say, depression or ADHD, they will require further evaluation (neuropsychological tests for ADHD, or psychiatric reports for depression). The CAA has become more open to pilots with past mental health treatment, but they will handle it carefully (often issuing a Class 1 with special monitoring or reports needed). For an initial Class 1, if you have such history, expect a deferral pending extra review rather than an outright denial.
Other Special Tests: Some AeMCs also do a balance/coordination test (like standing on one leg or a quick check of inner ear function) and blood pressure under exertion. You might also get a quick breathalyzer test for alcohol just to ensure you didn’t show up hungover (yes, they actually do this sometimes).
Interview and Summary: After all tests, the doctor(s) will compile results and discuss anything notable with you. If all is good, they issue the Class 1 certificate. If something needs review (say your ECG had an quirk), they might not issue that day and instead send results to the CAA cardiologist for approval.
All told, the initial Class 1 can take several hours (often about 3 to 4 hours, including waiting between different specialists). Bring snacks and water! The environment is usually professional and many find it interesting, it’s a thorough health screening. Try to relax and remember the staff are there not to “catch you out” but to ensure you’re safe to fly commercially.
Validity of Class 1:
A Class 1 medical is valid for 12 months if you’re under the age of 60. However, there’s an important caveat: if you are 40 or older AND you’re flying commercially as a single pilot carrying passengers (for example, an air-taxi pilot of age 45 flying a King Air alone with passengers), then your Class 1 is only valid 6 months at a time. Also, once you hit 60 years old, Class 1s become valid for 6 months at a time (even if you fly as airline crew with two pilots). Essentially:
Under 40 years: 12 months
40 to 59 years: 12 months if in multi-crew operations; 6 months if flying single-pilot operations carrying passengers
60 plus years: 6 months (no matter what, by ICAO rules an airline pilot over 60 must renew every 6 months).
Many airline pilots renew every 6 months anyway out of personal habit or company policy, some airlines require a 6-month renewal regardless of age just to be conservative.
Class 1 Renewal Exams:
After the big initial exam, your subsequent renewals (typically yearly) are usually done with an AME (unless you prefer the AeMC). Renewals are shorter: they’ll check your basic health, any changes, do a vision test, hearing test (audiogram every 5 years under 40, every 2 years over 40), an ECG annually (over 30: every 12 months for Class 1; under 30: every 5 years), and other tests as needed by age (e.g., blood tests maybe at age 40). It’s still more frequent and thorough than Class 2, but not as long as the initial.
Cost:
The Class 1 initial is significantly more expensive than Class 2 because of all the tests and specialists involved. Expect roughly £600 to £800 for the initial Class 1. It varies by centre and what tests are included (Gatwick CAA price is around that range). Renewals are cheaper, around £200 to £300 typically, since they are essentially an AME’s time and a few tests. Yes, it’s a lot of money, but compared to the cost of commercial flight training (about £70k plus for an ATPL), it’s a necessary investment. Plus, consider it an extensive health check that might save your life by catching an illness early.
If Something Goes Wrong:
If you don’t meet the Class 1 standards initially, all is not lost. Many issues can be worked through:
If you fail the colour vision or hearing for an unrestricted Class 1, you might be able to get a Class 1 with limitations (e.g., no night flying, or must wear hearing aids and have them checked).
If an ECG is abnormal, they may ask for a cardiologist’s report or a treadmill test, and often pilots are later cleared if the issue is benign.
If you have a medical condition, the CAA might issue a Class 1 with “Operational Multi-crew Limitation” (OML), which means you can only fly in a crew environment, not as single pilot. This is common for conditions that pose a small risk of sudden incapacitation, essentially, they’ll let you fly airliners (with a co-pilot who can take over) but not fly alone.
In the worst case scenario where you cannot get a Class 1, you can usually still get a Class 2 (private flying) unless the condition is very severe. So you could at least enjoy flying as a hobby.
Pro Tip:
As mentioned, get your initial Class 1 before investing in professional flight training. Many flight schools require you to have an initial Class 1 before they’ll enrol you in a CPL/ATPL course, for exactly this reason.
Bottom Line (Class 1):
The Class 1 medical is thorough because commercial pilots have more at stake. It can be nerve-wracking to go through, but most pilots do pass it. The vast majority of young applicants are found fit. It’s somewhat like a rite of passage into the professional ranks. And remember, the examiners are on your side, they want you to be able to fly, but they also have to make sure you’re not a risk to yourself or the public. When you do pass and get that Class 1 certificate in hand, it’s a fantastic feeling: it’s essentially your “license to fly for a living.” From there on, keep healthy and enjoy the journey.
Common Medical Worries & Precluding Conditions
A lot of would-be pilots lose sleep over whether some health issue or trait will prevent them from flying. Let’s address some of the most common worries one by one. The key point is: most manageable health conditions are not show-stoppers. The CAA has pathways for many issues to be accommodated. Only a few conditions are absolute no-go’s. Here’s a breakdown:
Eyesight, “Can I fly if I wear glasses or contacts?”
Yes, you absolutely can. Many pilots wear glasses or contact lenses, including airline captains. The medical standards require that your vision (with correction) be 6/6 (20/20) in each eye or better for Class 1, and at least 6/9 in each eye (with 6/6 binocularly) for Class 2, roughly.
In practice, if your eyesight is correctable to normal, you’re fine. There are limits on how severe your uncorrected eyesight can be. For instance, for Class 1 if you’re more than about -6.0 dioptres nearsighted or +5.0 dioptres farsighted, the CAA will require extra eye exams (and possibly may decline if extremely high because of future detachment risk). Class 2 is a bit more lenient on the extremes. Astigmatism up to around 2 dioptres is fine (if higher, might need special approval).
Importantly, if you do wear glasses or contacts, the requirement is that you carry a spare set with you when flying. For student pilots: don’t assume you can’t be a pilot just because you have a strong glasses prescription. Get an eye test and talk with an AME. Often it’s okay, or okay with certain lenses. Even post-LASIK or other laser eye surgery, pilots can be certified after a healing period and a stable outcome. The medical will want a report from your eye surgeon in that case, but many pilots fly post-eye-surgery without issues.
Color Blindness, “What if I can’t see those Ishihara numbers?”
Colour vision deficiency is relatively common (especially among males). During your initial Class 2 or Class 1, you’ll be given the Ishihara test, a booklet of plates with colored dot patterns. If you correctly identify the numbers hidden in those patterns, you pass. If you fail (i.e., you can’t see some numbers), for a private pilot (Class 2) the CAA can issue your medical with a restriction: “Colour Safe Flight Only”, which generally translates to Daylight Only flying (no night flying, because at night you need to read red/green airport lights and color light signals) and not valid for signal-controlled airspace (some very old-style light-gun controlled operations). For practical purposes, a colour-blind private pilot can still fly in daytime VFR without major issues. They just can’t obtain a full instrument rating (though they could get a restricted IR(R) that’s for UK only, possibly with limitation).
For a Class 1 (commercial), unfortunately, normal colour vision is pretty much required. An airline pilot must be able to distinguish colours on instrument displays, airport lighting, and so on under all conditions. If you fail Ishihara but still want a Class 1, the CAA may send you for a more sophisticated test (like the Farnsworth lantern or CAD test) to see if your deficiency is mild enough to still pass. If those are failed too, a Class 1 won’t be granted (or would be so restrictive, daylight only, that an airline wouldn’t hire you). So, colour blindness can indeed be career-limiting for airline aspirations. It’s better to find out early if you have this issue. If you do, you may focus on flying as a hobby instead, where it’s less of a barrier.
Hearing, “What if I’m a bit hard of hearing?”
Good hearing is important for radio communications. The standards allow some hearing loss as you age, particularly in higher frequencies, but you must be able to hear spoken voice clearly via headset. Typically, if you can hear normal conversation and ATC over radio with a headset, you’re okay. If someone uses hearing aids, they can often still fly (with a limitation to carry spare batteries and a backup). Profound deafness in both ears is disqualifying for most pilot licences that require radio use, though interestingly there have been cases of deaf pilots flying light aircraft under certain conditions (no radio, in uncontrolled airspace). But for practical PPL flying, you need functional hearing. If you have concerns, an audiogram will quantify it. Many older pilots have a bit of high-frequency loss but still pass with no issue.
Blood Pressure and Heart Health, “I have high BP; can I still get a medical?”
High blood pressure (hypertension) is very common and by itself usually will not ground you, as long as it’s controlled. The CAA allows pilots to fly on blood pressure medications (many of the common ones like ACE inhibitors, calcium blockers, etc., are acceptable, they prefer ones that don’t cause side effects). When you go for a medical, if your BP is high, the doctor might take multiple readings or ask you to relax for a bit because nerves can spike it. There is an upper limit (around 160/95 for Class 2, and a bit lower for initial Class 1) beyond which they’ll say “get this treated then come back”. But once you show it’s controlled, even with medication, you can be issued a medical certificate.
Serious heart conditions are more concerning. For example, a history of a heart attack (myocardial infarction) or bypass surgery will definitely ground you at least temporarily. The CAA can consider reinstating a Class 2 (and in rare cases even Class 1 with restrictions) after a heart attack, but you’d need to go through extensive cardiac evaluation (exercise tolerance test, scans, etc.) to prove your heart function is good and risk of another event is low.
Diabetes, “Can I fly if I have diabetes?”
This depends on the type and treatment:Diet-controlled or oral medication-controlled Type 2 diabetes: Yes, many pilots fly with this. If your blood sugar is kept in check with diet, exercise, or pills (like metformin), the CAA will want a report from your GP/endocrinologist and evidence that your HbA1c (a blood sugar level measure) is in a safe range. If well-managed, they’ll likely issue a Class 2 with perhaps a requirement for regular blood sugar checks and reports. For Class 1, diet-controlled diabetes can also be considered and often allowed if no complications.
Insulin-treated diabetes (Type 1 or advanced Type 2): This was historically an automatic “no” for commercial flying. However, the CAA (like some other regulators) has introduced strict protocols that may allow insulin-dependent diabetics to hold a Class 1 or Class 2 with limitations. Typically, for Class 2 (private flying), insulin use is allowed under what’s called “Safety Pilot” restrictions or stringent self-monitoring, meaning you must check your blood glucose before and during flight at intervals and perhaps only fly with another qualified pilot with you (if at risk of low blood sugar). The bottom line: diabetes is not an automatic career-ender, especially Type 2. Type 1 is more complicated but not an absolute bar to private flying nowadays.
Mental Health, “I had depression/anxiety. Will that fail me?”
Mental health conditions are handled carefully but compassionately. The CAA has been updating its approach to encourage pilots and applicants to be open about mental health. If you have a history of depression or anxiety, perhaps for which you took an SSRI antidepressant for a while, you can still get a medical.
If you are currently on an antidepressant, the CAA will evaluate:
What medication and dosage you are on
Why you are on it and how severe the condition is or was
How long you have been stable on it
Whether you have side effects
If all looks okay, the CAA may allow you to continue flying on that medication under a special issuance, often with regular follow-ups and reports. Important: you cannot self-certify on a PMD if you’re on medication for a psychiatric illness.
Absolute No-Gos:
Though the CAA tries to be flexible, some medical conditions are essentially incompatible with being pilot-in-command:
Uncontrolled psychosis or history of psychotic episodes
Dementia or significant cognitive impairment
Severe heart conditions that risk sudden incapacitation (e.g., uncontrolled angina, severe heart failure)
Certain implanted medical devices like a defibrillator (AICD)
Extreme vertigo or balance disorders
Substance dependence that is not in sustained remission
Active self-harm or suicidal ideation
Chronic illnesses that cause unpredictable incapacitation
However, for almost every condition not in those extreme categories, there’s often a path to keep flying either with a limitation or after treatment.
If in Doubt, Talk to an AME:
The best remedy for anxiety about medical issues is knowledge. AMEs are generally friendly and used to answering preliminary queries. If you have a medical condition and are unsure how it might affect your certification, you can usually call or email an AME for advice even before the examination.
Frequently Asked Questions
Now let’s answer some specific high-interest questions about pilot medicals. These are things that often pop up, especially among new pilots:
How much does a pilot medical cost?
For private flying (Class 2 or LAPL), you’re looking at roughly £150 to £250 for the examination. A Class 2 initial is often around £200, give or take. A LAPL medical might be a bit less (perhaps £120 to £180), since it can be shorter, but since most are done by AMEs, many charge nearly the same as a Class 2.
For a commercial Class 1, the initial Class 1 medical is much pricier: typically £600 to £800 in 2026. After that, Class 1 renewal medicals usually cost around £200 to £300 each year.
It’s also worth noting: the Pilot Medical Declaration (PMD) is free, it costs nothing to self-declare online (aside from the time to fill the form).
Can I be a pilot if I have ADHD?
Yes, it’s possible, but you will need additional steps and it depends on the severity. The CAA does not outright ban those with an ADHD diagnosis from holding a medical. However, because ADHD can affect attention and impulsivity (skills critical for safe flying), the CAA requires a thorough neuropsychological assessment for anyone with ADHD or a history of it.
Can I fly if I am colour blind?
For private pilots: Often, yes, with a restriction. If you are colour blind (meaning you fail the colour vision tests), the CAA can still issue a Class 2 or LAPL medical that is valid for daylight flying only.
For commercial pilots (Class 1): An unrestricted Class 1 medical requires normal colour vision. If you fail Ishihara but still want a Class 1, the CAA may send you for a more sophisticated test (like the Farnsworth lantern or CAD test) to see if your deficiency is mild enough to still pass.
Can I get a medical if I take anti-depressants?
Possibly, yes, depending on the situation. The CAA has become more accommodating with pilots who have been treated for depression or anxiety, including those on modern SSRI antidepressants. It is not automatically a no, but it typically requires stability, supporting medical reports, and AME assessment. Important: you cannot self-certify on a PMD if you’re on medication for a psychiatric illness.
Can I fly with diabetes?
Yes, in many cases you can, depending on how your diabetes is managed. Non-insulin diabetes is often compatible with a Class 2. Insulin-treated diabetes is more complex but may be possible with strict protocols and, in some cases, limitations.
What happens if I fail my medical?
“Failing” a medical can be a gut-punch, but it’s important to understand what kind of failure and what options exist. In many cases, an initial “fail” is actually a deferral pending more information. It’s also common to be eligible for a lower category even if you cannot hold a higher one (for example, Class 2 instead of Class 1, or LAPL instead of Class 2). Formal refusals can be reviewed and appealed.
How long are medical certificates valid for?
We touched on this in each section, but here’s a quick recap in one place:
Class 1 (Commercial): 12 months under 60; 6 months in certain cases (for example over 60, or some single-pilot commercial passenger operations).
Class 2 (Private): 60 months if issued under 40 (with age caps), 24 months from 40 to 49 (with age caps), 12 months from 50 and above.
LAPL Medical: 60 months under 40; 24 months from 40 and above.
Pilot Medical Declaration (PMD): valid until 70, then renewed every 3 years, and withdrawn sooner if you no longer meet the DVLA standard or PMD conditions.
Where can I get my medical examination done?
Class 2 or LAPL Medical: These can be done by any CAA-authorised Aeromedical Examiner (AME).Class 1 Initial: Must be done at a certified Aeromedical Centre (AeMC). The CAA’s Medical Department at Gatwick is a common choice.Class 1 Renewals: After your initial, you can go to an AME who is authorised for Class 1 renewals.
What if I develop a medical problem after I’m already a pilot?
If you’re already flying and something changes with your health, regulations say you must consult with an AME “without undue delay.” Depending on the issue, your medical might be temporarily suspended or you might be allowed to continue flying with monitoring. The rule of thumb is: When in doubt, sit it out, don’t fly if you feel unwell or have a condition that could impair you.
Conclusion & Next Steps
Stepping back, you’ll notice a theme: the pilot medical system is designed to keep you flying safely, not to keep you grounded. The vast majority of people who dream of flying will have no major hurdles to getting a medical certificate. And those who do encounter a hurdle often find a way over it, whether that’s through treatment, an alternate medical category, or a limitation that still allows some form of flying.
If you’re a new student pilot, hopefully this guide has demystified the process. Yes, there’s some paperwork and yes, you might have to pee in a cup or read an eye chart, but it’s a small price to pay for the freedom of flight. Most folks even find that once they’ve done their medical, a huge weight of uncertainty is lifted, “I passed! I’m fit to fly!”, and they can focus on training.
A few parting tips:
Get your medical early in training to avoid surprises.
Use the PMD if appropriate for easy entry into aviation, but be mindful of its limits.
Stay healthy: Treat it as part of your responsibility as a pilot to maintain a good standard of health. This doesn’t mean you need to be an athlete, just manage any conditions and live moderately.
Don’t be afraid of the AME, they truly are (or should be) the pilot’s ally. Be candid with them; they will work with you to find solutions if issues arise.
Most people pass: It’s worth reiterating, the large majority of initial medicals result in a certificate issued.
Now that you know you’re fit to fly, the next step is making sure you’re fit to pass your exams! Just as the medical ensures your body and mind are ready for flight, ground school prepares your knowledge and decision-making. QuizAero Bitesize, our online ground school, is the perfect companion to your flight training. We break down those daunting aviation theory subjects into manageable, bite-sized lessons (with the same clarity we aimed for in this guide). So, while you keep yourself healthy, let us keep your brain sharp and ready for passing those PPL exams with flying colours.
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