Occupational health referrals: what employees and managers need to know
Updated: Jul 27
A useful occupational health referral asks specific work questions, protects confidentiality and leads to decisions that managers and employees can act on.
An occupational health referral gives an employer independent advice about how someone’s health may affect them at work. It can inform decisions about fitness for work, a return to work and reasonable adjustments. It does not transfer the employer’s decision-making responsibility to the clinician.
The quality of the outcome depends on the quality of the referral. Managers need clear, job-related questions. Employees need to understand why the referral is being made, what will be discussed, who may receive a report and how the consent process works.
This guide explains the process from both perspectives. It is practical information rather than legal or medical advice.
What is an occupational health referral?
Occupational health is a specialist service concerned with the relationship between health and work. An occupational health professional may be a doctor, nurse or another appropriately qualified practitioner.
Unlike a routine clinical appointment, a management referral usually focuses on work-related questions. For example:
Is the employee currently fit for their role?
Could a change to duties, hours, equipment or working arrangements help?
Would a phased return be appropriate?
Is further review likely to be useful?
Are there relevant functional limitations or safety considerations?
The aim is not to give a manager unrestricted access to someone’s medical history. It is to translate relevant health information into practical advice about work. Acas explains that occupational health focuses on how someone performs their job and how the job may affect their health.
An occupational health report is advice. The employer still has to consider the circumstances, discuss the recommendations with the employee and make its own decisions in line with its legal responsibilities.
When can an occupational health referral help?
A referral can be useful when there is a clear work question that cannot be answered through an ordinary management conversation alone. Common examples include:
planning a safe and sustainable return after long-term sickness absence;
understanding the work impact of recurring or fluctuating health difficulties;
identifying possible workplace adjustments;
reviewing whether existing support remains effective;
considering health-related barriers to particular duties;
seeking role-specific advice where health and safety may be affected; or
resolving uncertainty when the employee, manager and treating clinician hold different information about work.
A referral should not be used as a fishing exercise for a diagnosis, a substitute for good management or an automatic first step whenever someone asks for support. Employers can often introduce sensible, low-risk changes while they wait for specialist advice. Our guide to support based on need rather than unnecessary proof explains how to create a practical starting point.
Before making a referral
The manager should be able to explain:
Why the referral is being proposed. What specific work decision or uncertainty needs advice?
What information will be shared. This might include the role, relevant duties, attendance information, existing support and the employee’s account of the situation.
What questions will be asked. Questions should be relevant, proportionate and linked to work.
Who is expected to receive the report. Access should be limited to people with a genuine need to know.
What happens next. Explain how recommendations will be discussed, decided upon and reviewed.
Where possible, show the employee the referral information and questions before they are submitted. This helps correct factual misunderstandings early and reduces the risk of a vague or one-sided referral.
The organisation should also have a clear occupational health policy. Acas recommends explaining when referrals or assessments may happen, how they will be arranged, the responsibilities of those involved and how any agreed action will be reviewed.
How to write useful referral questions
“Please assess this employee” is not a useful brief. The occupational health professional needs enough context to understand the work, but not an indiscriminate collection of personal information.
Good referral questions are specific and decision-focused:
Is the employee currently fit to perform the essential duties described?
If not, are they likely to be fit with temporary or longer-term changes?
What functional effects are relevant to the role?
What adjustments could reduce the identified barriers?
Would changes to hours, location, workload, communication, equipment or work patterns help?
If a phased return is suggested, what initial pattern and review point may be appropriate?
Is the situation likely to fluctuate, and how could the team plan for that?
When would a review be useful?
Are there role-specific health or safety matters the employer should consider?
Avoid questions that are broader than the work decision requires, such as requests for a full diagnosis, complete medical history or predictions the practitioner cannot reasonably make.
A simple manager referral template
Purpose of referral: We need advice to support a decision about [return to work/current duties/possible adjustments].Role context: The essential duties are [brief factual description]. The work pattern and relevant environment are [details].Current situation: The employee has told us [their relevant account]. We have already tried [support or changes], with the following outcome [facts].Questions: Please advise on current fitness for these duties, relevant functional effects, possible adjustments, expected duration and an appropriate review point.Report recipients and next step: Subject to the agreed consent process, the report will be received by [role/name] and discussed with the employee before decisions are made.
What employees can expect at an occupational health assessment
The appointment should begin with an explanation of the practitioner’s role, why the referral has been made, the questions they have been asked and how information may be used.
The practitioner may ask about:
the employee’s role and working environment;
the effect of health on particular tasks or work patterns;
the effect of work on health;
current treatment or support where it is relevant;
barriers, triggers and periods of fluctuation;
adjustments already tried; and
changes that could make work safer or more sustainable.
The assessment might take place in person, by video or by telephone, depending on the service and the questions involved. It is not necessarily a physical examination, and it should not become an unfocused review of every aspect of the employee’s health.
It can help to prepare a short note covering:
the main work barriers;
what a difficult day and a more manageable day look like;
support that has helped or made matters worse;
any time-sensitive concerns about work; and
the outcome the employee hopes the assessment will support.
If the occupational health service wants information from a treating doctor, there should be a clear reason for doing so and an appropriate consent process. Acas says the worker should be told why the information is needed and asked for signed consent.
Consent, reports and the right to see information
Consent is important, but several different questions can be confused:
Has the employee agreed to attend the assessment?
Has the clinician explained the purpose and scope of the assessment?
Has the employee agreed to relevant information being obtained from another clinician?
Has the employee agreed to the occupational health report being shared?
Does each organisation involved have an appropriate data-protection basis for its own processing?
These questions should not be collapsed into a single tick box.
Acas states that an employee does not have to agree to an occupational health assessment and that the occupational health adviser must ask for permission before sharing the assessment with the employer. If the employee declines an assessment or does not permit a report, the employer may still need to make a work decision using the information reasonably available. The employer should explain that possibility without pressuring the employee to reveal irrelevant medical details.
Where a doctor prepares the report, GMC confidentiality guidance says the doctor should ensure the person understands the report’s purpose, scope and possible consequences. The doctor should usually offer to show the report, or provide a copy, before it is sent, unless a recognised exception applies.
The precise legal right to see a report before it is sent depends on who prepared it and the circumstances. The Access to Medical Reports Act 1988 may apply to certain reports supplied by a doctor who is or has been responsible for the person’s clinical care. Employers and providers should explain which process applies rather than promising the same rights in every case.
If an employee identifies a factual error, they should raise it promptly with the clinician. A difference of opinion is not necessarily a factual error, but the employee can ask how disagreement will be recorded. GMC guidance also recognises that a person may withdraw consent before disclosure. Unless disclosure is required by law or justified in the public interest, the doctor must respect that decision. The commissioner may be told that no report will be provided, but that does not create permission to disclose further clinical information.
Confidentiality and data protection
Health information is special category data under UK data-protection law. Handling it properly requires more than obtaining a signature.
ICO guidance on workers’ health information says organisations need:
a clear and justifiable purpose;
an Article 6 lawful basis;
an Article 9 condition for processing special category data;
an additional Schedule 1 condition in some circumstances;
fair and transparent information for workers;
no more data than is necessary;
appropriate security and access controls; and
a defensible retention period.
The correct basis depends on the purpose and context. Employers and occupational health providers should each identify and document their own responsibilities. Permission for a clinician to send a report should not be treated as a substitute for the organisation’s wider data-protection duties.
Managers usually need practical information about fitness, functional effects and possible adjustments—not detailed clinical records. Access should be restricted to people who genuinely need the information for the stated purpose. The employee should know who may see it, how it will be used, how long it will be kept and how to raise a concern.
The ICO notes that its employment guidance is being reviewed following legislative change, so organisations should check the current version when setting policy or handling a complex case.
What a useful occupational health report should contain
A useful management report is concise, relevant and connected to the referral questions. Depending on the case, it may include:
the purpose and scope of the assessment;
the information considered;
an opinion on fitness for the specified work;
relevant functional abilities or limitations;
practical adjustment options;
whether recommendations are likely to be temporary or ongoing;
an appropriate review point;
answers to each reasonable referral question; and
any important limitations on the opinion provided.
The report should distinguish evidence, professional opinion and uncertainty. It should not include unrelated medical details simply because they were discussed during the assessment.
Recommendations should be specific enough to test. “Reduce stress” is difficult to implement. “For four weeks, agree priorities at the start of each week, limit simultaneous urgent tasks and review workload every Friday” gives the manager and employee something concrete to try.
For more examples, see reasonable adjustments employers can consider.
How managers should use the report
Receiving the report is not the end of the process. A manager should:
read the report against the original questions;
meet the employee to discuss the advice and their perspective;
consider each recommendation in the context of the role and the organisation’s obligations;
agree what will be implemented, by whom and by when;
record the reasons for material decisions;
set a review date; and
restrict the report and any health information to appropriate recipients.
Acas makes clear that occupational health can recommend adjustments, but the employer decides what action to take while considering both organisational needs and its legal obligations.
A recommendation should not be dismissed merely because it is inconvenient, nor treated as an instruction detached from the real work. If the exact recommendation is not workable, explore what barrier it was intended to address and whether another effective option exists.
If safe, proportionate support can begin before the report arrives, avoid making the referral a paperwork barrier. Occupational health can refine an approach; it need not be the gatekeeper for every helpful change.
Our article on common problems with workplace needs assessments covers similar implementation gaps, including recommendations that are too generic or never reviewed.
Common mistakes to avoid
Asking vague or diagnostic questions
Focus on work, function and decisions. A diagnosis alone rarely tells a manager what needs to change.
Sharing more information than is necessary
Provide enough role and case context to answer the questions, but do not attach an entire medical or employment history by default.
Presenting the referral as a disciplinary investigation
Be honest about the purpose. Occupational health advice should not be used to disguise an unrelated performance or conduct process.
Promising an absolute consent rule
Explain the actual process and any legal or public-interest exceptions. Do not promise that every report, provider and situation gives identical access or amendment rights.
Waiting for a diagnosis before discussing support
Managers can discuss barriers and consider practical changes on the evidence available. A later report may add precision.
Sending the report too widely
Share only what each recipient genuinely needs for the stated purpose. A line manager may need the recommended work changes without needing detailed clinical information.
Treating recommendations as either commands or optional extras
The employer remains responsible for its decisions. Consider the advice seriously, discuss it with the employee and document the outcome.
Assuming accreditation removes the need for due diligence
Quality standards help, but no badge replaces checking the service, practitioners, consent process, privacy arrangements and report quality.
Choosing an occupational health provider
When comparing providers, ask:
Who will carry out assessments, and what professional registration or qualifications do they hold?
How does the service explain consent, confidentiality and access to reports?
What information will the employer and employee receive before the assessment?
How does the provider keep clinical records separate from management reports?
How are factual corrections and disagreements handled?
What is the expected turnaround time?
Can the provider demonstrate that its reports answer referral questions clearly?
How does it manage data protection, retention, complaints and clinical governance?
SEQOHS, administered by the Faculty of Occupational Medicine, publishes standards for occupational health services. Its current standards are SEQOHS 2023. Accreditation can be a useful quality marker, but it is not a guarantee of legal compliance or future performance. Check the provider’s current status in the SEQOHS accredited-provider directory.
Frequently asked questions
Can an employee refuse an occupational health referral?
An employee does not have to agree to an occupational health assessment. The employer should explain why it is seeking advice and what may happen if it has to decide without that advice. Any resulting decision should still be reasonable and based on the information available.
Will the employer receive the employee’s full medical records?
Not as a routine part of a management referral. The report should be limited to relevant work information. The ICO says organisations should collect only what they need, and GMC guidance says doctors should disclose relevant, substantiated information rather than a whole record by default.
Does an employee have the right to see the report first?
The process depends on the practitioner, the source of the report and the circumstances. Acas says the occupational health adviser must ask permission before sharing the assessment. GMC guidance says a doctor should usually offer to show or provide a copy before sending it. Specific statutory rights may also apply to certain reports. Ask the provider to explain the process before the assessment.
Does occupational health diagnose conditions?
Some occupational health clinicians may be able to diagnose within their professional competence, but a management referral is normally focused on health in relation to work. A diagnosis should not be treated as a substitute for understanding the person, role and environment.
Must an employer follow every recommendation?
The employer makes the decision. It should consider the advice properly, discuss it with the employee and take account of its legal obligations. If a proposed change is not workable, it should explore effective alternatives rather than simply ignoring the barrier.
Can adjustments start before the report arrives?
Yes, where the employer and employee can identify a safe and workable change. Occupational health advice can then help refine, extend or review it.
Turn advice into workable adjustments
An occupational health report is advice, not an instruction or a diagnosis by proxy. Its value lies in translating health information into specific work decisions: what could change, who will act, when the change will be reviewed and how confidential information will be handled.
Managers should discuss recommendations with the employee, make reasonable decisions in context and record the agreed actions. If support can begin safely before the report arrives, avoid making paperwork a barrier.
Divergent Thinking’s non-diagnostic workplace needs assessments consider the person, role and environment, with purpose, access and consent boundaries agreed before the assessment begins.
Official sources used
General Medical Council, Disclosing information for employment, insurance and similar purposes
General Medical Council, Disagreement with an occupational health report
Information Commissioner’s Office, Data protection and workers’ health information
Information Commissioner’s Office, When can we share workers’ health information?
Information Commissioner’s Office, Workers’ health information checklists
SEQOHS / Faculty of Occupational Medicine, SEQOHS 2023 standards
SEQOHS / Faculty of Occupational Medicine, Accredited occupational health services
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