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Background Austroads has recently introduced a new set of guidelines for driving assessment in Australia. It is therefore timely to review the clinical approach to driving assessments, which is often seen as one of the most difficult areas of general practice. Objective This article reviews the difficulties of driving assessment, including what measures there are to guide general practitioners (GPs), and proposes a practical approach to this issue for general practice. Discussion There is as yet no widely agreed toolkit for office-based driving assessment in general practice. On-road assessment by a trained assessor, such as an occupational therapist, remains the gold standard. GPs should consider a stepped approach to driving cessation by raising this issue well in advance of the need for licence termination, working with the patient and the family through the driving cessation itself and providing follow-up support for the patient afterwards.