A managers guide to occupational health and referring for advice

This information is primarily concerned with management referral for staff, though the principles are largely applicable to student and on-offer referral as well.

On this page:

• What is occupational health?
• The role of the employer in managing risks to health
• Referral for occupational health advice
• Reasons for referral
• Work-related stress
• Questions to ask the OH practitioner to comment
• Points to note about an OH management referral
• Consent
• Receiving the OH report
• Requesting further medical information 
• Occupational Health and GP opinion
• Case conference or case discussion?

What is occupational health?

UCL’s occupational health service is delivered by Workplace Health department, part of UCL Human Resources Division. We are SEQOHS accredited as a safe, effective, quality occupational health service by the Faculty of Occupational Medicine.  

Occupational health (OH) considers how work and the work environment can impact on employees’ physical health, mental health and wellbeing and includes how an employee’s health can affect their ability to do their job. OH services help to keep employees healthy and safe whilst in work and to manage risks in the workplace that could give rise to work-related ill-health. 

All of Workplace Health’s (WH) occupational health clinicians are specialists in occupational health / medicine and offer a confidential assessment and impartial advice to support both the member of staff and manager / supervisor move forward with any health-related concerns. 

• We provide management referral assessments to all UCL staff, and students referrals to student groups we hold a contract with.  
• We also provide on-offer referral assessments for staff joining UCL who have declared a health issue to the recruiting manager.  
• UCL staff are able to access a self-referral appointment, but please note this does not generate an outcome report. 

The role of the employer in managing risks to health

Employers are required by law to do all they reasonably can to support the health, safety and wellbeing of their employees. Access to an expert-led impartial occupational health advice can help employers provide support so that their employees can manage work in the context of their health conditions. This, in turn, not only leads to better retention and return to work prospects, but also improves business productivity, which can be adversely impacted by sickness absence.  

Referral for occupational health advice

The main reason for referring an employee to occupational health is to help a manager resolve a situation where an employee’s health might be affecting their ability to carry out their job, or their job may be adversely affecting the employee’s health in some way. 

Work can help recovery from health problems or support wellbeing if you have a long-term health condition. Research shows that work can be good for your physical and mental health, lowers the risk of experiencing financial difficulties, and improves your overall quality of life (DWP, 2023) 

For referrals to be of optimum benefit to all, it is essential that the communication between referrers and the OH clinician is successful. The referral form is the managers opportunity to have a voice in the OH consultation and it is therefore important that you include as much relevant detail as possible, though please be succinct where you can. This should be the managers viewpoint and words. Please do not ask your employee to complete the referral on your behalf, and please avoid using text directly copied from an email in which your employee may have shared their health concerns.

Early intervention by referring to us as soon as you become aware of an issue can be helpful. If we are able to offer advice at an early stage, we may be able to support a quicker return to work. We also suggest not waiting for someone to be 100% better before planning a return to work, we can advise temporary adjustments to support an earlier return.  

Reasons for referral

It is critical that a manager is clear as to the reason for the referral and, consequently, the questions to ask the OH practitioner. The more specific the questions, the more likely they are to get answers that help them move the situation forward. 

If the referring manager has any questions or concerns about completing the referral they should seek advice from their HR Business Partners / local HR manager, who can also answer queries on UCL policy and employment law.  

Common reasons for seeking OH advice on an employee include: 

• Long-term sickness absence: Continuous absence of 4 weeks or more
• Ongoing health concerns: when OH advice might be useful in developing adjustments  
• Recurring short-term sickness absence: If an employee's level of absence reaches 12 or more working days (pro-rata), or 6 or more episodes in any rolling 12- month period (UCL’s sickness absence policy) 
• Work performance and / or behaviour concerns: Poor performance or behaviours potentially linked to health issues
• General health concerns: Worries about an employee’s health without impacting absence or performance
• Work-related illness / injury investigation: Determining if a health issue is work-related
• Ill-health retirement assessment: Evaluating if an employee meets the criteria for ill-health retirement
• Managing a sickness absence: When an employee has a treatment plan proposed for them by a medical specialist

Please include as much relevant detail about the situation as needed but avoid excessive information that might distract from the main issues. This could include: 

• Any health issues you’re aware of, even if not the primary reason for the referral. For example, if you are referring someone for back pain, its useful to know if you’re aware of any mental health issues or stress.  
• Any adjustments you’ve already tried and whether these were helpful or not.  
• If you’re aware of any personal issues impacting the employee’s wellbeing – or you can simply write that you’re aware ‘of difficulties outside of the workplace’. We can then follow this up in a confidential environment when we meet with the employee.  
• If you know what support they have in place, please share that with us to (this might be support networks, therapy / Employee Assistance Programme input). 
• Whether there are any formal management processes ongoing, for example performance management, sickness absence management, disciplinary or grievance. This is because these processes may significantly impact an employee’s wellbeing and their relationship with UCL.  
• The employee’s pattern of attendance over the twelve-month period (note we do not have access to this information without it being supplied). 
• A brief summary of relevant work demands and hazards. 

Our template referral form will support you in sharing the information we need to action the referral. Please also include any accessibility needs the employee has should an in-person assessment be confirmed.    

Please do not refer employees to us to approve purchases of furniture, equipment or software. This is a decision to be made by departments and detailed advice on equipment and / or furniture can be obtained from the Digital Accessibility team. 

Work-related stress

• Please refer to UCL’s guidance on managing stress.

'Duty of care' is a legal obligation to exercise a reasonable level of care towards others to avoid causing harm. Under UK law, employers have a duty of care to their employees. This means they must take reasonable steps to ensure the health, safety, and wellbeing of their employees while at work. 

This includes: 

• Providing a safe and healthy working environment
• Protecting staff from discrimination
• Carrying out risk assessments

Where an employee cites work-related stress as a reason for absence, we advise that a stress risk assessment is completed as soon as practical, even if you decide not to refer to us in Workplace Health.

Referral is not necessary in all cases of stress, however there are some circumstances where occupational health advice can be of benefit. These include:

• Where there are other underlying health problems that have been triggered or exacerbated by stress which may require additional consideration and support, such as anxiety and depression.
• When the employee is off work with stress, particularly if it has been for two weeks or more.
• When the working relationship between the manager and employee has become difficult or broken down.

Questions to ask the OH practitioner to comment

Here are some useful questions for managers to consider, some of which are populated on the referral form for you to select. This is not an exhaustive list.

• Is the employee medically fit to work in this role? 
• When, if absent, are they likely to be able to return to work? 
• Would the employee’s condition be covered by the disability provisions of the Equality Act (2010)? (note we can share an opinion on the likelihood of this, but coverage is a legal matter and would be confirmed by an employment tribunal). 
• Are any adjustments needed to help the employee in their work? 
• How long adjustments might be required for? 
• Are there any restrictions in what the employee can do in their role? 
• Is the employee receiving the appropriate medical care and support? 
• Should the employee be considered for ill-health retirement? 
• Is the employee’s illness caused or exacerbated by their work? 
• If the employee is taking medication, is it likely to impair their ability to do their job safely and effectively? 

Some questions are best avoided: 

• Please can you review the employee. This is too vague. We need to understand from you the line manager your perceptions of how the health issues are impacting on the employee.   
• What are the details of this person’s illness? This is confidential information which we will discuss with the employee. This won’t usually be shared. What is important for a line manager is knowing the functional impacts and practical implications of a condition.  
• What medication is the employee taking? See above.  
• It is important that there are no surprises for the employee in a referral, as the clinician will go through the form with the employee at the beginning of the consultation. If you have a performance or behaviour concern, this must not be the first time the employee is made aware of it. 

Points to note about an OH management referral

Clinicians always have to work within their own set of medical ethics and guidelines; the most important of these is the preservation of patient confidentiality. The challenge then for an OH practitioner is to know how much medical information to put in the report. Essentially, it is more useful for the manager to know about the employee’s functional abilities and prognosis (if known) – what they can or cannot do in their job, and when they might get better – rather than any medical details. 

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

Upon receipt of the management referral form, one of the Senior OH Advisors (SOHA) will assess the form for completeness against the following criteria to confirm it meets a number of criteria. If it does not, the SOHA will email the referring manager and explain what else should be added. A quality management referral is the foundation of a successful management referral process. 

Quality: 

• Is the reason for referral clearly stated and understood?​ 
• Has the referring manager given an overview of the health issues and how they impact on the employee's work?​ 
• Has the referring manager shared what their concerns are about the situation?​ 
• Has the referring manager asked appropriate questions for us to respond to?​ 
• Has the referring manager used their own words, not pasted the wording from an email the employee wrote?​ 
• Is the referral asking for OH approval or advocacy in relation to funding or equipment?​ 

Completeness: 

• Has the full form been completed? ​ 
• Is the form legible?​ 
• Has the aligned HR Business Partner been named?​ 
• Has a telephone number for the client been provided?​ 
• Is the declaration fully completed?​ 
• Has the RM signed off the referral? 

Consent

The management referral form is the chance for your voice as a manager to be heard in the OH consultation and you should document the situation as fully and honestly as you can. It is essential that you discuss with your employee the reason you wish to refer them to us, and to brief them on what you have written and why.  

An employee does not need to consent to be referred to Workplace Health nor do they have to agree with the wording in the referral document. At the beginning of any consultation, the OH clinician will talk through the referral form with the employee and explain the management referral process to them, including confidentiality. At that point we will ask for the employee’s consent to proceed with the consultation. If they decline, we will advise you we were not able to proceed. The HRBP will be able to advise you further at that point. 

At the end of the consultation, we must obtain the employee’s consent for us to release the OH report to the manager. All clients (employees) have the right to request to review the report we have written. Not all clients exercise that right, and if they chose not to, we would send you the report directly. When a report has been requested for prior viewing before we release it, we ask clients to respond within 2 working days to consent to its release, and we will email a reminder if we have not heard from them. 

Clients have the right to request the OH clinician to make amendments to a report if we got something factually incorrect, however they are not permitted to change our advice or opinion. 

We aim to release the OH report to the referring manager within 48 hours of the consultation. However, this is subject to the employee’s consent, and it can take longer where the employee has had prior access to the report and requests amendments to factual information. 

At any stage in this process a client may withdraw their consent, and we will then notify you that consent has been withdrawn and we will not be able to issue any report or comment further. 

Receiving the OH report

If there is anything in the report for which you need further clarity, in the first instance, please contact the clinician who authored the report. If we have advised that a stress risk assessment is required, we recommend that you schedule a second meeting to work through this with your employee.  

Upon receipt of an OH report, the manager should discuss the content with the employee in a confidential setting and agree a plan to move things forward. In a complex situation you might find it helpful to discuss the report with the HR Business Partner that is aligned to your area.  

As part of the meeting, please consider the recommendations in the report, and whether you can implement these. If you are unable to implement them, please explain to your employee why they aren’t practicable.   

As a reminder an OH report contains advice and recommendations, as well as an opinion on the fitness to undertake or return to the role. 

• The report is not an instruction. Whether or not the advice can be implemented and followed is for a line manager to decide, given the needs and context of the service / business delivery, and the resource that is available. A manager will need to consider costs, impacts on other staff, the ability to deliver critical work safely etc, to be able to ascertain if adjustments are reasonably practicable. 
• The report is objective and impartial. We are neither advocates for the employee, nor do we have a pre-agreed agenda with the referring manager. Our role is to support a positive resolution to a health concern impacting both the employee and the delivery of a role.  

We welcome feedback on our reports and would encourage employees, HR Business Partners and line manager to use the link we share at the bottom of all our reports. 

Requesting further 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 Workplace Health (on behalf of UCL) must pay a charge. This is only requested 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. We usually expect this process to take about 6 weeks, but it does sometimes take longer.  

Under the Access to Medical Reports Act 1988 (AMRA), the employee’s written consent is required for OH to request a medical report. If the employee wishes to view the medical report before it is sent to OH, they have three weeks to review it and provide their consent. 

Depending on the health issue, the employee's progress might need to be assessed again when the report is received, and an updated OH report may be issues at that time.  

Occupational Health and GP opinion

Whilst OH opinion does not override that of a GP, the employer is entitled to take the medical opinion it chooses. It is perfectly reasonable for you to take the opinion of the OH service, as this is a 'specialist' opinion, with knowledge of the employee's health condition and knowledge of the employee's job role, workplace and working environment. The Fit Note tells the manager whether the employee’s GP thinks they are not fit for any work, or whether they may be fit for some work (not necessarily their current job). Please note Fit Notes are not issued to confirm fitness to return to work, and OH does not routinely need to confirm fitness to return to work before the employees comes back from a period of ill-health. An employee does not need permission from the GP to return to work before the expiry of the fit note. 

Case conference or case discussion?

We are sometimes asked to be involved in a ‘case conference’. This is usually where there are complex needs and adjustments suggested, and the manager and employee are finding it difficult to agree a way forward. This is an opportunity for the manager, HRBP, OH clinician and employee (and their representative should they wish to invite one) to all meet and talk through any queries or concerns, with the aim of reaching a common understanding of the issues and agreeing a way forward. The HRBP or manager would be responsible for setting up and chairing the meeting, taking any notes and sharing any actions agreed with the employee after. OH should see the employee before the meeting, and agree with them what information can be shared at the meeting. The role of the OH clinician in a case conference is to help clarify any points in their OH report. 

A case discussion is a meeting between the OH clinician, the referring manager and the HRBP about an employee who has been seen by OH, where the referring manager and HRBP are seeking clarity on the content of the OH report.  As with a case conference, OH can clarify points in the OH report that has been provided,  

In neither scenario would the OH clinician be able to answer any additional health related questions about the employees' individual circumstances. Nor can the OH clinician change their opinion which has been provided in their OH report. If you have further questions, or if the situation has changed, you should submit a further management referral form and we will schedule a further assessment.