Employer's guide

An Occupational Health service is there to give you advice, to help you manage employees where there are health issues of concern.  These are mostly the effect of an employee’s health on their ability to work, but can include the effect of work on an employee’s health.  The process for seeking advice is usually to do a Management Referral. It is helpful to us to know what advice you are seeking, and the referral allows you to ask the relevant questions. If you are not sure what advice to seek, ask HR to help, or email admin@workingfit.com

Reasons for requesting a Management Referral

The main reason for a management referral is a problem with performance at work.  This can be a problem with attendance, a problem undertaking certain duties, a problem with relationships with other staff, or a concern that certain duties might affect future performance.

Some employees have frequent or prolonged sickness absence, and it is important to have an agreed policy for managing sickness absence. This may have trigger points, such as numbers of absences in any three or six month period, or number of days off in a year. It is important to include a copy of the sickness absence record with any referral.

Where attendance is of concern, managers should discuss this first with the employee at Return to Work interviews. Reaching a trigger point should not automatically lead to a Management Referral. There may be a clear reason for past absence that is unlikely to recur, or there may be no other issues of concern in relation to performance, so there may be no benefit from requesting OH advice.

Poor attendance may not be a problem, but managers may still need advice in relation to medical conditions or disabilities that have an impact on work.

A referral would usually be expected where:

  • Absence levels are having a substantial impact on the team or the department.

  • The individual is having difficulty performing tasks or reaching targets because of poor attendance

  • The individual has had an operation or has a temporary medical condition and may be able to work with adjustments

  • The individual may be absent for a prolonged period and advice is needed on duration to enable cover to be arranged

  • The individual is unwell at work and appears to be attending when they should be off sick because of high motivation or fear of repercussions (presenteeism)

Information to include in a Management Referral

OH staff are experienced and able to give general advice without necessarily being asked specific questions.  They will only be able to respond to specific questions if these are asked in the referral.

There are only three sources of information available to OH staff. One is the employee, from questions asked during the consultation. The second is from management, from information provided in the Management Referral.  The third is from medical records, either from the GP or specialist.  If no information is provided, the report will be based entirely on what the employee says in the consultation. If the manager has copies of medical reports and doesn’t send them to OH, OH staff will not know what these reports state.

If you are asking for advice on sickness absence it is important to include the full sickness absence record including dates of absence and reason given for absence if this is recorded. It is also important to note what has been discussed at Return to Work Interviews, and whether warnings about attendance have been issued.

If you are asking for advice on adjustments it is helpful to state what adjustments are already in place, and what might be available.

If the employee appears to have an impairment or disability it is important to state what this is in general terms and how it affects the employee in their role. The line manager will have a much better knowledge and understanding of this than OH staff, who will only have perhaps twenty minutes to assess impairments. They will not see the employee in the work environment, and many employees may exaggerate or underplay symptoms during the consultation.

While we encourage managers to ask questions, answering them will take time. It is generally not necessary to ask more than three or four key questions.

It is essential to discuss the referral with the employee so they are clear why they are being referred, and are clear about the likely outcomes particularly if dismissal is a potential outcome of the process. It is best practice to gain signed consent from the employee during this discussion.  Arrange a meeting with the employee to discuss the referral. You need enough time to explain the issues, and discuss likely outcomes, so this should be arranged formally with time in the diary, not just a quick chat in the corridor.

What to expect from OH

Most occupational health appointments last around 40 minutes. If the case is complex, or if you want to ask more than three or four questions, the OH practitioner may need an hour or more. Complex cases include most mental health issues, cases where there are multiple medical conditions, and cases of unclear or undefined pathology such as chronic fatigue or chronic pain. If you request an appointment you will be asked whether this is a routine 40 minute case or a complex one, and the charge will be agreed. Please don’t ask for a routine appointment if the case is complex as you will be charged the higher amount anyway and there will be disruption to timings for the rest of the clinic.

If the case is particularly complex or a home visit is required, then a bespoke appointment can be arranged. Where there are bulky medical records to be read this can take several hours and this will be included in the charge.

The OH practitioner will take some time to get a full history of the relevant medical and work issues. This usually requires some questions about past medical history and about any stresses and pressures at home as well as work. All the information discussed is confidential and is kept secure in the individual’s OH file. Only OH staff can access this file.

OH practitioners are normally able to base their advice on the information provided by the employee, but sometimes further information is needed from the GP or specialist. Signed consent is needed for this, and it can take several weeks and longer on occasions to get a reply. There is nothing the OH department can do to speed this process up.

A report will be written for management and HR, and the OH practitioner will endeavour to answer all questions raised by the manager. The employee has to give consent to this report before it can be sent, and the employee can ask to see a copy beforehand.

Adjusted Duties

Where adjusted duties are necessary or may be helpful, either for a short period to help the employee settle back to work or recover from illness, or long term if there is a disability, these will be recommended by the OH practitioner. Adjustments can include a reduction in hours, altered duties, special equipment or assistance, or working from home.

The final decision whether adjusted duties are reasonable in the circumstances lies with management. Most long-term adjustments are needed in relation to disabilities under the Equality Act and this will need to be taken into account.

Where adjustments are likely to be needed for longer than three months, it can be helpful to arrange a Case Management meeting. This may include the individual, manager, HR, OH, and a Union representative.

Equality Act 2010

Employers often want to know whether the employee is likely to be disabled in accordance with the Equality Act 2010. This helps management fulfil their obligations under this Act. While it may be unlawful to discriminate against disabled employees, and there is an obligation to provide reasonable adjustments, not all adjustments requested are reasonable. Management have to determine whether adjustments are reasonable in the circumstances, which should take into account cost, practicality and the impact on other members of staff.

While the Equality Act requires an employer to make reasonable adjustments if there is a disability, many employees aren’t disabled but still need adjustments.  For example someone who has fractured a limb may well be able to do some work while recovering, or someone who has just had major surgery may be able to return on lighter sedentary duties while they recover.  It is usually very sensible for employers to make reasonable adjustments for everyone who needs them, particularly if the employee is being paid substantial sick pay while they are not at work.

Employers may be advised to ask questions in occupational health referrals in relation to the Equality Act 2010.  Often some of these questions are much better answered by the line manager who knows the employee well.  The occupational health practitioner may well never have seen the employee before and is only likely to have 20-30 minutes to assess them.  They can only do so by asking the employee.   In these circumstances it is much better to tell the occupational health practitioner what the observed impairments at work are, and ask whether these are due to an underlying condition, whether this is treatable, and what adjustments might help. 

Ethical issues

There are legal and ethical constraints that must be adhered to when making an occupational health assessment and preparing a report. The Data Protection Act 1998 applies to all records made and information stored. All records are confidential.  The content of the report, and opportunity for the employee to see the report, are covered by ethical guidance from the General Medical Council and Faculty of Occupational Medicine

In some cases further information will be required from the employees GP or Specialist. If a report is needed this will usually cost the employer somewhere in the region of £25-100 depending on the nature of the report. The Access to Medical Reports Act 1988 applies to these reports, so the employee has additional rights. They can ask to see the report before it is sent to us, and in these circumstances they are allowed 21 days in which to arrange to see the report. There may be an administrative charge by the GP/Specialist for this. The employee can refuse to allow the report to be sent, or can specify modifications to the report.

When Working Fit prepare a report on an employee this is usually typed during the consultation and shown to the employee to allow them to ask questions and to ensure that the report is an accurate statement of the facts of the case.  Where more time is required to prepare the report, for example after a review of notes in an ill health retirement or insurance case, the employee is given the opportunity to see a copy of the report by email either 48 hours before it is sent to the employer, or at the same time.  Email is preferred to post because an encryption system is used so the process is more secure.

In many cases inclusion of the diagnosis and an explanation of how the condition can affect work is very useful for both the employer and employee. Clinical information is, however, only included with the consent of the employee, and only clinical information relevant to the particular employment situation will be included.