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 makes a referral useful, what happens next, and the questions employees and managers most often ask.

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.
• 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.

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.

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.

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?
• 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.

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.

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.

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.