Occupational Health and Wellbeing Service

Advice provided by Occupational Health & Wellbeing (OHWB) in the referral process is primarily designed to support the referring manager in their decision making when dealing with a workplace health-related issue. Following an assessment of the health problem by an OH Clinician a report will be provided to the referring manager. This report is not a “medical” report but a “management” report designed to answer specific questions asked by the referring manager to provide guidance in managing the situation and fitness to work.

Our aim is to make this as smooth and timely a process as possible. The points below will help you to understand the process and to make the best use of our service, but please do not hesitate to call contact us for support and guidance at any stage of the process.

Reasons for Referral

There are many and varied reasons for wishing to obtain independent advice in relation to an employee, but the commonest reasons include:

• Long term sickness absence – usually defined as continuous absence of 4 weeks or more.
• Recurring short terms absence – based on episodes and their frequency, within a defined time-frame.
• Concerns over work performance – poor or reduced performance levels where there may be a health problem.
• Concerns about an employee – where there is a genuine worry for the individual’s health even though there is no real impact on absence or performance (e.g. general behaviour).
• Investigation of work-related illness/injury – assessment of whether a health problem is likely to be work-related or not.
• Medical Redeployment – an assessment of capability to match to the requirements of the job, as well as evidence of illness or injury.
• Ill-Health Retirement assessment – an OH Physician will advise whether the criteria for ill health retirement may be met. In ill health retirement cases it is usual for evidence to include an assessment of capability, matched to the requirements of the job, as well as medical evidence about illness or injury. In the NHS Pension Scheme the final decisions on release of pension benefits lies with NHS Pensions not OH.

Please note that OHWB does not:

• Expedite referrals to other specialists or primary care practitioners. OHWB cannot refer directly to any consultants for health conditions; these should be managed by the individuals GP.
• OHWB do not supply or authorise provision of workplace equipment e.g. desks, chairs or IT equipment.
• Cannot support requests for shift changes in the absence of a health issue.
• Pregnant workers should only be referred if an issue has been identified on a pregnancy risk assessment.
• There is no need to refer to OHWB for employees who require counselling; please direct these staff to the Employee Assistance Programme for assessment and support

Completing a Management Referral Form

The reasons for the referral MUST first be discussed with your employee. They must be fully informed as to why they are being referred to OH and what information you, as their manager, require from the OH assessment. The electronic signature on the back of the form indicates that they understand the reasons for the referral and consent to attending OHWB on that basis.

Managers must ensure that all contact details entered on to the referral form are up to date and accurate; as out of date information can create delays. A copy of the referral must be given or sent to the employee so that there are no surprises when the staff member attends OHWB,

It is essential that key information is provided to the assessing OH Clinician, and the quality of this information is vital to the effectiveness of the referral process and the subsequent management report back to the manager.

Without adequate background information the OH Clinician may be unable to fully assess a problem and respond to the questions asked. Managers should provide a summary outline of key factors of the job, particularly aspects that may impact the health condition of the individual – a job description can be useful.

You should keep a copy of the form for your records.

Questions That May Be Relevant To Include

These are some of the questions you may wish to consider in relation to individuals specific circumstances. 

• Is the employee currently medically fit to undertake their duties or any alternative work?
• If currently unfit, is the employee likely to be medically fit to undertake their duties or any alternative work in the foreseeable future? (If so please detail the timescales)
• Are there any modifications or adjustments that could be considered which would assist the employee in undertaking their duties?
• Are the modifications or adjustments likely to be short term or permanent?
• Is there an underlying medical reason for recurrent short term absence?
• Is any underlying health problem likely to improve and, if so, in what time scales?
• Are further absences likely and at what level?
• Is the illness caused or made worse by work activity?
• Is their health problem likely to meet the criteria for disability as defined by the Equality Act 2010?
• Is the employee fit to attend an investigatory or disciplinary process?

If there is ever any doubt about how best to word a referral, the manager should contact the OHWB department for guidance.

Managers also need to be aware that all information sent to OH regarding a referral (including any supplementary emails, letters or phone calls) will form part of an individual’s occupational health record and will therefore be available to them in line with the requirements of the Data Protection Act.

Report to the Referring Manager and Confidentiality

Confidentiality is central to the functioning of an OHWB service. It is a requirement for all OHWB clinicians to respect patient confidentiality, and this is made clear in GMC, NMC and Faculty of Occupational Medicine guidance. A breach of patient confidentiality is therefore a professional misconduct issue and all our staff, including the administrative personnel, are required to sign a confidentiality agreement on commencing work with Harrogate & District Foundation Trust.

Confidentiality will not inhibit the quality of advice provided to managers. However, it is important that employees can trust OHWB. If employees do not believe the occupational health assessment process is medically confidential; they are unlikely to be honest and open about their health issues. This can then sometimes compromise the effectiveness of the process.

When reporting to management, some clinical information may not be included, unless it is expressly permitted/agreed by the referred employee. It is, however, possible to provide responses to the questions asked without releasing confidential information. For example, a manager can resolve a health related issue without knowing the actual diagnosis as long as they understand some of the key functional issues and what they can do to assist.

Additional Medical Information

In some cases it may be necessary to obtain further medical information from the employee’s General Practitioner (GP) or Specialist. This is usually in the form of a report for which the GP or Specialist may charge. This is only done therefore; where there are clear benefits in doing so. For example, where specific medical information may influence the view of a prognosis, where information may be required to confirm aspects of the employee’s clinical history or to clarify issues and/or obtain specific details. All of which may influence the final report to the manager.

What Happens Once the Report is Received?

You should arrange a meeting with your employee to discuss the contents of the report.

If modifications or adaptations have been advised, discussions with the employee should cover how these can be implemented. Although you have received the advice from OHWB you may still need to contact HR as they might need to be involved with this part of the process.

Please note that the opinions expressed in the report are based on specialist clinical knowledge and experience of the workplace and are therefore not subject to negotiation or amendment. However, if you have questions about the report, or it does not provide you with the information you requested or require, you should contact the OH Clinician whose name appears at the base of the report to discuss your queries.

The advice given by the OH Clinician is just that, advice. You, as the manager, have to consider whether the advice given to you is practical to implement taking into account organisational factors. However, you would also need to be able to justify why you didn’t implement the advice, having sought it, should the situation end up as an employment tribunal case.

When to Refer Again?

You will have been given details in the report if the OHWB Clinician wishes to see the individual again – you should find this detail somewhere near the end of the report.

If a review appointment has not been advised the case will have been closed. In this instance if further OHWB advice is needed by the manager, another referral form should be submitted. This could be because of a new health issue, a change in the employees’ health or change in workplace environment

Employee Perceptions versus Management Perceptions

The OHWB Clinician will independently assess the situation, taking into account their experience in dealing with occupational issues and their specialist knowledge of the workplace. A detailed history will be taken, including details on relevant, and past health issues, treatment, day-to-day restrictions, and work issues. Where appropriate the OHWB Clinician may undertake a clinical examination to determine functional capability. This then provides a more balanced view of the problem that will stand up to scrutiny and challenge.

It is important to remember that sometimes there are two different views of the same situation. In reflecting to the manager the perceptions of the employee this does not mean the occupational health clinician is ‘taking their side’. If a manager is not made aware of differing views then this cannot be discussed with the employee. Unresolved differences may serve as a barrier to a return to work.

It does therefore highlight the need for you, as the referring manager, to be as vigorous as possible in providing sufficient detail to help the OHWB Clinician to obtain that balanced view of the problem.

Recommending that your employee makes a self-referral means that your viewpoint cannot be taken into consideration and the assessing clinician will be unable to give a balanced opinion to allow you to manage the situation. Asking your employee to self-refer does not shorten the process – in fact it can often lengthen it. It also tends to negate your managerial responsibilities.

If you would like further advice about referring to OHWB then please contact us on 01423 553400 (Monday to Friday, 08:00 to 16:00 hours, excluding Bank Holidays) or email [email protected]