Occupational Health Referrals: A Guide for Employers

An occupational health referral is how an employer asks for impartial clinical advice about an employee’s health in relation to their work. This guide covers when to refer, what a referral form should contain, what makes a referral useful, what happens next, and the questions employees and managers most often ask.

The referral process at a glance

In short, a referral goes through five stages:

1. Tell the employee. Explain why you are making the referral and what it is for, before it is sent.
2. Write the referral. Give the job, the history and the specific questions you need answered.
3. The appointment is arranged. The employee agrees to the assessment.
4. The clinician assesses. The consultation takes place in person, by video or by telephone.
5. You receive the report. Share the recommendations with the employee before acting on them.

The rest of this guide takes each stage in turn.

What an occupational health referral is

A referral is a request for advice. The employer sets out the situation and the questions they need answered. An occupational health clinician then assesses the employee and advises on fitness for work, adjustments that would help, and likely timescales.

It is advice, not a decision. Occupational health does not sign people off, does not dismiss anyone, and does not decide whether an adjustment is reasonable. Those remain management decisions. What occupational health provides is the clinical picture an employer needs in order to make those decisions properly, and a documented basis for having done so.

When to make a referral

• Absence. An absence that is prolonged, frequently repeated, or where the underlying reason is unclear.
• Fitness to return. Planning a return to work after significant illness, surgery or injury.
• A change in health at work. Where performance, conduct or safety appears to be affected by health.
• Adjustments. Where an employee has requested changes, or where the duty to consider reasonable adjustments under the Equality Act 2010 may apply.
• Safety critical roles. Where a health condition may affect an employee’s ability to work safely. See safety critical medicals.
• Capability and ill health retirement. Where a role may no longer be sustainable in its current form.

Refer early. The most common mistake is referring at the point a decision has effectively been taken, when advice can no longer change the outcome.

Some cases need a specialist focus. We offer psychiatry, musculoskeletal and wellbeing services, and if burnout is the concern, see understanding burnout and how occupational health can help.

Who can make a referral

Most referrals are management referrals, made by a line manager or by HR. Some employers also permit self-referral. In either case the employee must consent to the assessment, and they should always know a referral has been made and why. A referral that arrives as a surprise starts the process badly and often ends in a refusal.

Management referral or self-referral?

Most referrals are management referrals: the employer identifies the need and asks the questions. Some employers also allow self-referral, where an employee requests an assessment directly. The two are not interchangeable, and using the wrong one causes problems later.

Management referral

The right route whenever the outcome will inform a management decision — a return-to-work plan, a capability process, an adjustment, a safety-critical fitness check. The manager sets out the job, the history and the specific questions, and receives a report they can act on. This is also the route required wherever the employer needs to show, later, that it sought advice before acting.

Self-referral

Appropriate where an employee wants advice for themselves without a management decision attached — for example, general guidance on managing a condition at work, or a second opinion before raising something with their manager. Self-referral reports are typically shared with the employee rather than the employer, unless the employee agrees otherwise. It is not a substitute for a management referral once a decision is pending: an employer that needs to make a decision should make its own referral, with its own questions, rather than relying on advice given to the employee alone.

Employers unsure which applies can ask us before submitting — it takes a two-minute call to establish, and referring the wrong way round is one of the more common reasons a report comes back less useful than expected.

What makes a good occupational health referral

The quality of the advice depends almost entirely on the quality of the referral. A referral asking only for advice on fitness for work will receive a general answer, because a general question has been asked.

What to include

• Specific questions. The single biggest improvement most employers can make. Ask what you actually need to know.
• The job. A job description, the physical and cognitive demands, shift pattern, driving requirements and any safety critical elements.
• The history. Absence dates and pattern, what has already been tried, and what effect it had.
• What has been discussed with the employee already, including anything they have told you about their health.
• Any constraints. Redeployment options, what adjustments are realistically available, and relevant policy timescales.

What to avoid

• Asking for a diagnosis. It is not what you need, and it is not information the employer is entitled to.
• Asking whether the absence is genuine. Occupational health cannot answer this and should not be asked to.
• Asking us to make the decision. We advise; you decide.
• Sending a referral the employee has not been told about.

Occupational health referral form: what it should contain

Most employers use a form, either their own or their provider’s. The layout matters less than what goes in it. Whatever form you use, it should cover the following. If yours does not, that is the first thing to fix.

1. The employee. Name, job title, department, and who is making the referral.
2. That the employee knows. Confirmation that they have been told about the referral and why, and have agreed to attend.
3. The reason. A short, factual account of the situation.
4. The job. A job description, the physical and cognitive demands, shift pattern, and any driving or safety critical duties.
5. The history. Absence dates and pattern, and what has already been tried.
6. The questions. Numbered, specific, and answerable by a clinician.
7. The constraints. Adjustments or redeployment that are realistically available, and any policy timescales.
8. Who receives the report. A named contact, and who to call with questions.

The questions are where most forms fall down. The examples that follow show the difference, and the list of questions worth asking gives you wording to start from.

A weak referral, and the same one done well

The difference between a referral that produces a useful report and one that doesn’t is rarely the situation — it’s what’s written on the form. Here is the same case, done both ways.

Weak

“Please assess [employee] for fitness to work. They have been off sick on and off for a few months and we need to know when they’ll be back.”

This is not enough to work with. There is no job description, no history, no indication of what has already been tried, and no actual question — “when they’ll be back” is a request for a prediction, not clinical advice. The report that comes back will be general, because a general question was asked.

Good

“[Employee] is a warehouse operative — role involves repeated lifting up to 20kg and a full shift on their feet. Absence pattern: three periods since March, each 2–3 weeks, all recorded as lower back pain. Their GP has referred them for physiotherapy, first appointment pending. We’ve discussed light duties informally but haven’t found anything that works within the current shift pattern. We need to know: (1) is a phased return realistic once physiotherapy starts, (2) what temporary adjustments to lifting or shift pattern would help, and (3) whether we should expect this to resolve or recur.”

Same employee, same condition — but this version gives the clinician a job to compare against, a timeline, what’s already been tried, and three specific questions. The report that comes back will answer those three questions directly, which is what turns an occupational health report into something a manager can actually use in a return-to-work meeting.

Questions worth asking

• Is the employee fit to carry out their current role in full?
• If not, what adjustments would help, and for how long would they be needed?
• Is this condition likely to be long term or recurrent?
• When is a return to work realistic, and in what form?
• Is a phased return appropriate, and over what period?
• Are there restrictions relevant to driving or to safety critical duties? For Group 2 licence holders, see driver and DVLA medicals.
• Is any further information needed from the employee’s GP or specialist?

What happens at the assessment

The employee attends a consultation, in person, by video or by telephone depending on what the case requires. The clinician takes a history, discusses the demands of the role, and assesses the functional effect of the condition on the ability to do the job. No treatment is provided and the clinician does not take over care from the employee’s GP. If you are unsure which type of assessment to request, see our guide to the types of assessment.

The focus throughout is functional. The question is not what the condition is called, but what the employee can and cannot currently do, and what would change that.

The report, and consent

The report answers the questions that were asked. It describes functional effect and recommendations rather than clinical detail, and it should be written so that a manager can act on it without needing to interpret medical language.

Consent is required both for the assessment and for the report to be released. Faculty of Occupational Medicine guidance regards offering the employee sight of the report before it is sent as good practice, and where the clinician has been responsible for the employee’s clinical care the Access to Medical Reports Act 1988 gives specific statutory rights. An employee may ask for factual corrections. They cannot require an opinion to be changed.

What happens after the report

The report is advice, not the end of the process. The most common mistake at this stage is treating it as a decision that’s already been made, rather than the basis for a conversation still to be had.

The conversation to have with the employee

Share the recommendations with the employee before acting on them, even where you’re not obliged to share the full report. Talk through what’s being proposed, what it means in practice, and over what timescale. An employee who hears about their own adjustments secondhand, or finds out that a decision was made from a report they never saw, is far more likely to raise a grievance — regardless of whether the recommendations were reasonable.

If you can’t implement a recommendation

Occupational health advises on what would help; it doesn’t know what’s operationally possible in your business. If a recommended adjustment genuinely can’t be accommodated, say so and explain why, and consider going back to occupational health with the constraint named — a revised recommendation that works within it is often possible. Simply not actioning a recommendation, without explanation, is the scenario most likely to be scrutinised later.

Reviewing and closing out

Set a review date wherever the recommendation is time-limited or the condition is expected to change — a phased return, a temporary restriction, a “review in six weeks.” An adjustment left in place indefinitely with no review becomes the new normal by default, which is rarely what either side intended.

If you have been referred to occupational health

If your employer has referred you, they have asked for clinical advice about your health in relation to your work. A referral is a request for advice, not a decision. Occupational health does not sign people off or dismiss anyone.

You should be told that a referral has been made and why, and you have to agree to the assessment. Attendance cannot be compelled.

The clinician will ask about your health and your job, and assess how your health affects your ability to do it. They do not provide treatment and do not take over from your GP. The report your employer receives describes what you can and cannot currently do and what would help, rather than clinical detail. Your consent is needed for the report to be released, good practice is that you are offered sight of it before it is sent, and you can ask for factual corrections.

Most concerns come from not knowing what will be shared. If that is yours, ask before the appointment.

Can an employee refuse an occupational health referral?

Yes. Attendance cannot be compelled, and no one can be assessed without consent.

There are consequences, though, and they are worth explaining rather than threatening. If an employee declines, the employer must make its decisions without clinical advice, on the information it already holds. That rarely works in the employee’s favour, because advice is the mechanism by which adjustments get recommended and timescales get defended.

In practice most refusals come from not understanding the purpose. The employee assumes the report will hand their medical history to their manager. The most effective remedy is explaining clearly what will and will not be shared, before the appointment rather than after the refusal.

What if an employer refuses to make a referral?

There is no general legal duty on an employer to refer. Refusing can still be risky for them. Where a disability may be in play, a tribunal considering whether reasonable adjustments were made will ask what the employer knew and what steps it took to find out. Declining to seek advice is not a strong position from which to answer that.

An employee who wants a referral can ask in writing, set out why they believe their health is affecting their work, and raise it through the grievance procedure if the request is refused.

How long does an occupational health referral take?

Three stages determine the timescale: arranging the appointment, the assessment itself, and the report.

The usual cause of delay is none of these. It is a case where further information is needed from a GP or treating specialist, which puts the timeline outside the provider’s control. The second most common is a referral that arrives without clear questions or a job description, which means the clinician has to go back and ask. Referrals that arrive complete move fastest, which is the practical argument for spending ten minutes more on the referral form.

Frequently asked questions

Making a referral to R-Health

R-Health is physician-owned and physician-run. Referrals are assessed by consultant occupational physicians rather than passed to a screening service, which matters most in the cases likeliest to be challenged later.

See our occupational health assessment services for what we cover, or get in touch to discuss a referral or set up a referral process for your organisation. Our clinic is in Edgware, north-west London: see occupational health in London.