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Referral to Occupational Health: Guidance notes

The University of Exeter is committed to providing, as far as it is reasonably practicable, a healthy and safe working environment for its staff and students.

Managing sickness absence is an important element of demonstrating a supportive attitude towards individuals and the overall efficiency of the University. Sickness absence management requires sensitivity and the support of line managers and the Human Resources team. Successful returns to work depend on the constructive co-operation of all parties involved, even though not all illnesses and injuries are caused by work (or by work alone). One key element to managing sickness absence is encouraging staff to attend work. Problems relating to sickness absence can be frustrating and are often difficult to deal with. Ultimately, it is the responsibility of all staff to take ownership of their health and welfare and managers need to be sympathetic and supportive to staff who become ill.

Purpose of this Guidance

General supportive action will often achieve the effect of improving and maintaining an employee's attendance to an acceptable level. There will however be some cases where it is appropriate for managers to take formal action under the capability procedure. The following guidelines are intended to help managers treat all cases of sickness absence in a fair, consistent and constructive way. A balance needs to be struck between the effective running of the University and the necessity for members of staff to have appropriate time away from work from time-to-time to recover from an illness or injury.

This guidance should be read in conjunction with the University of Exeter: Managing Absence Code of Practice (which includes a section regarding the Capability Procedure).

Role of the Occupational Health Service

The Occupational Health (OH) Service will offer as much support and advice to staff as practicable. OH cannot (and should not) be regarded as a replacement for the advice or care being given by the employee's own doctor(s). However, OH will offer the expert advice needed in assessing an employee’s 'fitness for work', (i.e. despite there being a health problem).

The quality of advice given by OH following a referral will to some degree depend upon the quality of the information provided by managers in their referral (in addition to the information given by the member of staff during their OH consultation). If information within the referral is inaccurate, or if important points are omitted, the advice from OH is likely to be flawed.

Absence monitoring

The University has a formal process for the recording and monitoring of sickness absence (see Managing Absence Code of Practice). It is recommended that managers (often first line supervisors) talk to members of staff on, or soon after, they return to work (i.e. undertake a 'return to work discussion'). This may be only a brief discussion where a member of staff has taken only one short period of time off work for a minor illness. The return to work discussion is an informal intervention for managing sickness absence and can be very useful for gathering information about an ongoing or recurrent health problem for a member of staff.

Reasons for referring staff to Occupational Health

There are likely to be three main reasons why members of staff should be referred to OH:

  • long-term sickness absence (usually a period of sickness lasting 28 consecutive days or more);
  • frequent or persistent short-term sickness absence due to a health problem;
  • poor or failing performance, the cause thought to be associated with a health problem.

Long-term sickness absence

Long-term sickness would normally be considered an absence from work due to an illness or injury lasting 28 consecutive days or more. If the reason for this absence is clearly going to lead to a long-term absence (e.g. the fracture of a major bone, major surgery, malignancy, a major heart attack or stroke), a formal referral is unlikely to expedite a return to work during the early stages of recovery. However, an early intervention (referral) can sometimes be useful if/when contact is likely to be required later on in the recovery process. Each case of long-term sickness absence should be treated on its own merit. Sometimes, simply offering a member of staff the contact details of the OH service should they want to make contact is less threatening than a request for them to make an appointment in the early days of an illness/injury.

Short-term sickness absence

Short-term sickness would normally be considered an absence from work due to an illness or injury lasting less than 28 consecutive days.

Frequent or persistent sickness absence

Frequent or persistent sickness is considered to be an absence from work due to an illness or injury:

  • on more than 4 separate occasions in a rolling period of 12 months;
  • multiple absences totally 12 working days or more (pro-rata for part-time staff) in a rolling period of 12 months;
  • regular Monday and/or Friday absences, or days before and/or after bank holidays;
  • regular absences occurring at times of increased workload, pressure or working to deadlines.

If a member of staff is taking frequent short-term sickness due to what appears to be a health problem which is affecting their ability to work effectively, a referral to OH would be appropriate. If the reason(s) for these absences are not medical in nature, the member of staff should be managed within their own College/Service by their line manager and/or a senior member of staff (and the HR Business Partner where appropriate).

Poor or failing performance

Issues relating to poor performance can be difficult to manage. The capability of staff can be affected by many factors other than their health (e.g. the effectiveness of the initial recruitment process, the information and training provided, the appropriateness and condition of work equipment, available resources, or basic negligence). Good skills in people-management will naturally minimise many of these factors, but all potential reasons for an employee's failing performance should be considered.

The prime responsibility for monitoring and handling poor performance on a day to day basis lies with the supervisor/immediate line manager. Line managers have the closest contact with their staff and are therefore more likely to recognise a problem at its start. Line managers are also more likely to know about any circumstances that might be affecting an individual's attendance (e.g. difficult personal or domestic circumstances). Line managers are also best placed to address problems and offer appropriate support at a very early stage.

Where poor or failing performance is thought to be secondary to a health complaint (i.e. it is considered that health concerns are leading to a fall in performance), OH will see the member of staff and consider whether ill-health is a likely to be the cause. OH will offer advice as appropriate.

Misconduct and disciplinary procedures should not be initiated where ill-health is identified as the cause of poor performance. Where it is believed that ill-health is not the cause of poor performance, the member of staff will be referred back to the HR Business Partner and they should be managed in accordance with University's Capability/Performance Procedure.

Disability Discrimination

Managers regularly ask OH whether the Disability Discrimination Act (DDA) applies to members of staff, particularly in connection with their sickness absence. A factual answer to these types of questions can only be given by an Employment Tribunal, but OH practitioners will offer guidance in relation to the DDA by advising on an employee’s fitness to work, their limitations at work and recommend adjustments where appropriate.

Further guidance on the DDA can be found on the Equality and Human Rights Commission website.


OH referrals should be made by an HR Business Partner, following discussions with the line manager/supervisor of the member of staff concerned. A formal OH referral form (PD36) will need to be completed.

Where additional information from the line manger or supervisor is likely to be helpful, the line manager/supervisor should be encouraged to provide a supplementary report for clarification of the facts and the issue(s) deemed to be problematic. (The supplementary information may be included in form PD36 or attached separately.) Any supplementary information provided may be disclosed to the employee under the Data Protection Act/Freedom of Information Act unless there are justifiable reasons for keeping it confidential.

It is important that all personal and contact information about the member of staff being referred is up-to-date and accurate. A record of the employee's sickness absence (ideally over the last 2 years) should be included with the referral form. A job description must accompany all referrals.

It is imperative that any member of staff being referred to OH should be informed about the referral (i.e. notified that a referral has been requested and the reason/s for this referral). A copy of the completed referral form must be given/sent to the member of staff being referred.

In the unusual circumstance of a member of staff refusing to attend an OH appointment, it should be explained that within the ‘conditions of employment' the University has a contractual right to refer any employee to the OH service (or a nominated doctor), when there is a concern regarding their health or level of attendance. Members of staff are therefore expected to attend an OH appointment if it is deemed necessary by their HR Business Partner. If a member of staff would be happier attending an OH appointment with a colleague or friend, this is perfectly acceptable. OH should be advised if the employee is attending reluctantly or wishes to be accompanied.


When a member of staff has been formally referred to the OH service, a written report would normally be sent to the referring HR Business Partner by post or email. This report will be copied to any named person identified in Section D of the PD36 referral form (normally the immediate supervisor and/or line manager). Data protection legislation requires that only managers who ‘need-to-know’ should receive a copy of the report and that those individuals who do receive a copy of the report treat this as confidential.

Data protection legislation and professional codes of practice prevents doctors and nurses from disclosing any clinical information about their patient (i.e. the referred member of staff), without the patient's informed consent/permission. Therefore, reports containing clinical information will only be sent (to those named on the referral form) with the consent of the employee/patient.

If consent is denied, a report will still be sent, but it will not contain any clinical information. This report will however offer an opinion regarding the employee's fitness to work and any limitations that their medical condition might have on their ability to carry out their normal role. Advice regarding reasonable adjustments will be offered if or when necessary.


OH will consider whether a formal follow-up from each referral is required at the time of their appointment. Where a follow-up is necessary, this will be indicated in the OH report. OH will arrange for any follow-up appointment(s) to be undertaken at the appropriate time(s).

When OH formally 'discharges' a member of staff from their care, any further referral should be processed in the same way as a new case.

Process summary

  • When a line manager/supervisor with their HR Business Partner identify a member of staff for whom advice is needed regarding fitness to work, there should be an open dialogue between the manager and the member of staff concerned. The referral, and the reason for it, must be discussed with the employee.
  • All referrals should be made by a HR Business Partner on form PD36. The form should be completed in full and forwarded to OH by post or email (it does not need to be addressed to a specific/named person in OH).
  • The member of staff must be copied into the referral document(s). During the meeting with the employee, OH will discuss the information provided in the PD36 referral form and any attached documents, so OH will normally treat all information provided by the manager(s) as part of the referral process as discloseable to the employee.
  • Exceptionally, if there is any relevant information that needs to be communicated to OH as part of the referral which should be kept confidential from the employee, a separate document should be completed and clearly marked "Confidential to Occupational Health: not for disclosure to [name of referred employee]" and sent with the other referral documents. OH will contact the HR Business Partner making the referral if keeping this information confidential is likely to be problematic or a concern.
  • OH will send an appointment to the member of staff concerned, normally within 5 working days.
  • OH will aim to see (or at least offer an appointment date) to referred members of staff within a fortnight of receiving the completed referral form.
  • OH will aim to report back to the referring manager within 5 working days of the OH consultation. OH will telephone the relevant manager with a preliminary report ahead of a written report if there is likely to be a delay beyond 5 working days.

Referral form: Notes for completion

Section A: It is important that the information regarding personal details is accurate and up to date, because this will form the basis of the information needed to make contact with the employee/‘patient’.

Section B: Details of the line manager will make communications between the person managing the referred person and the OH service easier.

Section C: The HR Business Partner referring the member of staff will require a report and their details are therefore required.

Section D: It is likely that more than one person will need to know the outcome of the OH consultation (although the number of people being copied into any report should be kept to an absolute minimum). A report would normally be sent to the person referring the member of staff (usually the HR Business Partner), the first line supervisor and the second line manager.

Section E: It is useful to know whether the member of staff being referred to OH is currently off work or at work. If they are off work currently, or were away from work recently, it is helpful to have an accurate history of their absenteeism, because the employee/‘patient’ is often vague about the details of their absences.

It is imperative that any member of staff being referred to the OH service is informed about their referral and they are provided with a copy of the completed referral form.

The reason for a referral is important and OH will need to know the specific reason why a member of staff needed to be referred. It is not helpful if all four questions are ticked on every referral made.

Section F: If the reason for a referral is for advice regarding fitness to work, (i.e. Q1. at Section E), the OH will need to know what work is actually being undertaken and a Job Description will need to accompany the referral form. Where no current job description exists, a brief outline of the primary tasks/duties will suffice.

If the reason for the referral is regarding sickness absence (i.e. Q2. at Section E), the OH will need to see a record of any absenteeism for the previous 2 years (or for the period of time the member of staff has been in employment if that is less than 2 years). This can be printed or hand written, but should include dates, the reasons for any absence and whether time off was self-certificated or accompanied by a doctor’s certificate.

If the reason for the referral is with regard to performance/capability (i.e. Q3. at Section E), the OH will need specific and evidenced information in that respect.

If the reason for the referral is the result of a general feeling of concern regarding a member of staff’s health or wellbeing (i.e. Q4. at Section E), the OH will need to know what those concerns are and what might have led to them.

Section G: Please explain, as concisely as possible, what it is you want to know as a result of this member of staff being seen in occupational health. If you require specific advice then you will need to ask specific questions, i.e. if you do not explain what it is you want then you are likely to be disappointed with any report that results from the consultation. Please bear in mind that any medical report regarding a member of staff can only be written and sent with that member of staffs’ consent. Please date this form.