Managing staff who are on long-term sick leave is challenging for Practice Managers. Can we contact them? How long is long enough? How can I get them back to work? In April’s HR Clinic, Robyn Clark (aka JacksonR) and Susi O’Brien (HR Help advisor) answered all your questions on this tricky subject.

Here is a summary of the questions we received, and the answers given.

Do I have to use Occupational Health to manage long-term sickness?

I mean, you don’t have to, but I’d STRONGLY advise it! If you’re looking to terminate employment, then a tribunal will expect you to have obtained some form of medical input about the employee’s health condition and likelihood of being able to return to work.

Besides, Occupational Health can be absolutely brilliant if used properly and you’ve got a good provider. You need to really get the most out of your referral. Ask the questions you want answered! They do have to answer them as it’s a service you’re paying for! Ask them things like, “What can we do to support so-and-so’s attendance?” Enclose a copy of the job description so they know what the employee is being asked to do and ask Occupational Health if they’re capable of doing it. Ask them for advice and suggestions on how to get them back into work. And if you’ve done things already, highlight what you’ve done and then find out what the barriers to returning are. It’s a service that’s there for you as well as the employee.

How do I access Occupational Health, as there doesn’t appear to be any available locally? I have requested a GP report instead for now.

There don’t seem to be many areas where Occupational Health is provided or funded by another body, for example, the LMC, so you really do just have to find a company and commission them to take on the referrals. For some conditions like mental health, a face-to-face appointment might not be necessary and it can be done over the phone, which broadens your scope for finding a provider as they don’t necessarily need to be local. I don’t find that GP reports are particularly helpful if they agree to do them at all, as they’re not specialists in this field, whereas Occupational Health is. So, whilst it may be an annoying expense, it really is worth it. I can’t stress enough how important getting specialist medical advice is when managing sickness absence.

What if the employee doesn’t agree with the Occupational Health advice?

They are entitled to do so. The best thing to do is to have a conversation with them about it and find out what it is they don’t agree with. If it’s that Occupational Health think they can return to work, and they don’t, then that makes your job even easier really in determining whether to go down the dismissal route. If Occupational Health thinks they shouldn’t be at work, but they disagree, then get them back in! But I’d recommend doing a documented risk assessment confirming that they’re going against the advice given and putting a plan in place if all doesn’t go as expected. If you’re significantly concerned that the Occupational Health advice is correct, and the staff member could be endangering themselves by ignoring it, you can always ask for a second opinion or a specialist opinion with the employee’s consent.

And if they disagree with the advice so much that they don’t give consent for you to see it at all, then all you can do is proceed as best you can without the benefit of that medical advice. You tried at least!

When someone is on long-term sick, do you have to give them formal warnings before you consider dismissal, as you would with normal sickness absence?

No, your long-term sickness management process should be slightly different from the short-term process. I’m personally not a fan of “warnings” for sickness management, but that’s a conversation for another clinic!

Your long-term process is about meeting with the staff member, and at each opportunity trying to establish a return-to work-date. If none is forthcoming, then you’ll move towards the potential dismissal option. A warning doesn’t need to be issued.

If someone returns from long-term sickness, you’d still do a return to work review and include the absence in your usual sickness management procedure, so it might be that they trigger a warning on return.

Occupational Health reports – presumably, they’re just guidance and will ultimately say the employer and the employee need to agree on what is acceptable. How will this help?

I’d be cautious about calling them “just guidance”. They’re reports from medical professionals, and an employment tribunal will look at them as medical evidence. They will expect you to have acknowledged their recommendations, discussed them with the employee, and implemented them where reasonable. Every report received should be followed by a meeting to discuss its contents and the potential implications for the employee and the practice.

Occupational Health can be amazingly helpful if you write the right referral! So many reports can come back with nothing specific because you need to ask the right questions in the first place. As a starter for ten, I always include:

• A copy of the employee’s job description so the Occupational Health clinician knows exactly what the role entails, then they should be able to see how the health condition might impact on that
• A brief absence history so they know how much sickness has occurred in the past 12 months
• Ask the question: Is there anything the practice can do to facilitate a return to work?
• Ask the question: When can we expect the employee to return to work?
• Ask the question: Does the clinician feel the health condition could be classed as a disability?
• Ask the question: Can we expect any further absences as a result of this health condition, and if so, what do they think is a reasonable level of attendance that we can expect of the employee?
• Ask the question: Is there anything we can do to help the employee maintain a good attendance level?

There’s also a Practice Index guidance document to help you word Occupational Health referrals: Occupational health referral questions guidance for managers [PLUS]

If the report doesn’t cover my questions, I go back to them and ask them to answer them! From the answers, it should give you a good idea of how much absence you can expect, which may mean adjusting targets for a disability, and anything you can do to help keep the employee in work. A good Occupational Health report can actually be really helpful!

How long can someone be off before it’s fair to dismiss them?

Great question! This will, however, depend on a variety of factors. How long can the practice sustain the absence? You should also take into account the individual – how long have they been with you? Is the health condition likely to resolve? If someone is off with a broken leg, then you’d just need to accept it as there will be a time when that break heals and the person can return. But if someone is off with something like mental health problems or long-standing back pain, this isn’t as clear.

You’ll need to take into consideration how long it will take to follow your sickness management process; as part of this, you need to refer the individual to Occupational Health, review their responses, and meet the employee to discuss their absence and any potential return to work. The timeline can be protracted by employees feeling like they can come back, setting a date to return and then not being able to do it. Most long-term absences could be classed as disabilities, so you need to be considering reasonable adjustments and what you can do to help the employee return to work.

You may also want to factor in sick pay. Once the employee has exhausted their sick pay entitlement, they may be doing themselves an injustice by staying on. They may be excluding themselves from financial support by being employed.

The main issue for me is when there isn’t a foreseeable return-to-work date – so I’d really advocate for asking Occupational Health this question when you’re referring. If there’s no foreseeable return-to-work date, then it opens up the opportunity to have a conversation about the employee’s options.

Phased returns – striking a balance between what’s reasonable and what’s not.

We get this one a lot. How many of you have seen a ridiculous proposal from someone returning from long-term sick leave? I think I had one once, back in my secondary care HR days, where a staff member wanted to start on one hour a week and then build up an hour at a time, and they were on an 18-hour-a-week contract!

My rule of thumb is this:

You should be returning on at least 50% of your contracted working hours. If you can’t do that, then it’s very likely that you’re not really fit to return to work at all and should continue to stay off to recuperate. Now, that might be 50% of a newly agreed number of hours – some people, when you’re managing their absence, may request to reduce their hours permanently, and if you’re agreeable, you need to set this at 50% of their NEW hours.

The phased return should be completed within four weeks ideally. So, Week four is back to 100% of their contracted hours. You can extend this, but I’d be calling this “exceptional circumstances”, and I’d only extend it to six weeks in total. If they can’t come back to 100% after six weeks, then you need to be having a conversation about whether they need to permanently reduce their hours, if you can accommodate that, or if they’re really fit to return to work at all.

How can we dictate to return to full hours in six weeks if their GP agrees to continue on reduced hours?

The GP isn’t in charge of your policies and procedures, so whilst they can make a recommendation, if it isn’t sustainable for the business, then you don’t have to implement it. Make sure your Occupational Health advice is up to date and, if not, go back and ask them what the potential is for the staff member to return to their normal hours. If this isn’t possible within a reasonable time frame, then you’re free to discuss other options – which could be a permanent reduction in hours, or if they’re not able to return to the role fully at all then you may need to move towards considering dismissal.

How do you manage long-term sickness with someone who was under performance management prior to going off sick? They have gone off with anxiety.

Sadly, this happens quite a lot – if another HR process is commenced, the employee goes off sick with stress. So, in this case, your performance management process needs to be placed on hold as you can’t performance manage someone who’s not there – and your sickness management process takes over. Early intervention is key here. If the stress is being caused by the performance management, how do we stop that? By getting it over with! Highlight to the employee that it’s not going away, but that the aim of performance management is to support them to be able to carry out their role to the right standard. It’s meant to be supportive, not punitive. You can also refer the employee to Occpational Health and give the context of what’s going on. Occupational Health will say exactly what I’ve said: the best way to manage stress is to get it over with!

We have a receptionist who’s been off sick for about eight months now. We’ve kept in touch and had meetings along the way. Occupational Health say there’s no likelihood of them returning to work. We therefore want to dismiss, but how do we do this?

Firstly, well done for following the steps of your policy! This should make it easier for you to close the process off. You need to arrange another sickness meeting, which you need to formally invite the employee to. They need to be aware that there’s the potential for their employment to be terminated on the grounds of ill health at this meeting, and they’re also entitled to bring a union representative to the meeting. Give them enough notice to help facilitate this, if required – normally, a week is enough.

At the meeting, you’d review the Occupational Health advice and check if the employee agrees that they’re unable to return to work. Ensure you discuss other options, if you haven’t before – e.g., redeployment to another role, reduction in hours, etc. If it’s still a no-go, then you’ll have to dismiss and give the appropriate notice. The employee may be eligible for ill health retirement depending on the reason for their absence, so it’s worth mentioning this to them as they’ll need to instigate the application process for this.

It’s always good practice, especially for a long-standing colleague, to confirm what the team can be told, and offer them the option of a leaving do if you normally would for other staff. You should also give the employee the right to appeal the decision to dismiss.

How do we communicate opportunities to staff, such as new roles when they are on maternity / long-term sick to ensure staff are included?

First of all, well done to you for remembering that you DO need to do this! There have been countless tribunals where staff have successfully claimed discrimination at work for being passed over for promotions because of parental or long-term sick leave.

As we’ll mention countless times on this topic, managers should set a plan of communication with any staff member who’s on long-term sick or parental leave and cover how they’d like to hear about any opportunities that might arise. This will be specific to each individual so there’s no one-size-fits-all approach here. It could be regular phone catchups, you could agree to send information to their personal email address, or some people might still be checking their work email. Just have a conversation and make an agreement between you.

We recruited a Nurse five months ago, but her absence levels have been horrendous. She’s currently off sick for the fourth time, and her latest fit note takes her past her probation end date. Can we dismiss in these circumstances?

The obligations on you during the first two years of employment are not as onerous as for someone who’s been with you for longer. And probation is there for this reason – to ensure you’re getting the right level of service from the employee. However, just be careful not to take things too quickly. You need to ensure that these absences are not related to a disability. Has the employee declared any underlying health condition? Are the absences for the same thing, and could this be the beginning of an underlying health condition? If you’re confident that there’s no potential for disability, then extending the probation deadline due to absence isn’t unreasonable – and as I’ve said, employees don’t have permanent rights before two years, so you wouldn’t be doing anything illegal in letting it go over the initial planned review date. It’s always better to dismiss based on failed probation so I’d advise having that meeting once the staff member has returned to work. If they’re not likely to return to work, then follow your long-term sickness management process.

A lovely member of the team has gone off sick recently, mental health related. It’s not a huge surprise as she’s clearly been struggling for a while, and I’m worried that this is going to be a long, protracted absence. Is there anything we can do to help her try and get back to work sooner rather than later?

Absolutely! Early intervention is key if you ask me! Offer Occupational Health early on. Have you got access to counselling for staff, or an employee assistance programme? If so, refer her to them ASAP. Keep in contact – how are things going, what is she doing to get help, is there anything you can do? It’s also worth highlighting that maintaining a routine can be good for mental health; this keeps the brain active, stops people feeling isolated and gives them peer support – and work can form part of that. Just ensure your approach is one of compassion and support, and not just trying to keep them in work as that can backfire on you!

If they tell you that work stress is a factor in their health problems, then carry out a stress risk assessment as well, to see if there are any steps you can take to reduce that pressure when they return to work.

Is Statutory Sick Pay paid for a maximum of 26 weeks?

Almost – it’s 28 weeks! You need to check the wording of your contract/sick pay policy on this too, as mentioned before. If your occupational sick pay includes SSP then that clock starts counting down from day one of their absence. If your occupational sick pay is additional to SSP, then you need to keep an eye on when the SSP entitlement starts being drawn on. Once it’s run out, the employee is sadly entitled to nothing. My advice is to regularly update on pay entitlements so staff know what’s happening, and if it looks like they’ll go down to nil pay, I’d advise them to speak to the DWP about any financial support they might be entitled to.

An employee is currently off on long-term sick leave. They were entitled to eight weeks of sick pay, which have just about run out, but at five years’ service, this increases to 12 weeks. Their fifth anniversary is in a few weeks’ time, and they think they’re entitled to another four weeks of sick pay at this point. Is that right?

Ooh, that’s a tricky one! It would depend on whether anything is stipulated in your contract or sick pay policy. It’s natural for staff to want to keep their pay going for as long as possible (they have mortgages or rent to pay, after all), so I recommend that the wording in your sick pay terms is clear on this point.

For example, the Practice Index template employment contracts and sick pay policies stipulate that entitlement to sick pay is based on your length of service on the start date of absence. Therefore, unless there’s a break in absence along the way, it won’t matter how long someone is off or what work anniversaries happen during that time – their sick pay entitlement won’t rise until they’re back at work. (Unfortunately, Practice Index has not been able to add this clause in salaried GP contracts as it’s not compatible with the usual model BMA terms.)

If the wording in your practice’s sick pay terms is unclear on this point, you may need to pay them the extra four weeks of pay when they hit five weeks of service. This is especially the case if your sick pay entitlements are contractual, as most practices’ entitlements tend to be.

Do staff have to apply for ill health retirement before dismissal?

No, staff can even apply for it ages after they’ve left your employment if they’re still eligible under the terms (i.e. if they’re younger than retirement age). You will probably still be contacted to write an application in support if you were their last NHS employer, so make sure you keep their staff records if you think this is something that might crop up. Part of the application process is to also confirm what management support was provided to the staff member around their illness, so it’s really important that you follow your sickness policy and document all of the interactions you’ve had with them over their health. Staff can apply beforehand and if it gets approved, they will need to either resign from their post or be dismissed for the funds to be made accessible.

What if an employee went off sick during disciplinary proceedings, saying they’re suffering from stress/anxiety?

Well, the easiest way to remove the stress is to conclude the disciplinary proceedings, right? You need to clarify to the staff member that being off sick doesn’t make it go away, and while they’re off sick, they’ll be managed in accordance with your sickness policy. This is also where Occupational Health can be really helpful too. Do a referral, asking if the patient is well enough to participate in the disciplinary process. It’s incredibly rare for them to say no. There’s a huge difference between being well enough to come back to work to do your normal job and your normal hours than there is to being well enough to attend a meeting. So, I’d get that referral in as soon as possible. Occupational Health will also reinforce that the easiest way to reduce the stress is to get the process over and done with.

We’ve had someone off for the past six months, but it’s known that they went on holiday abroad (Facebook, of course!). Since then, the other staff members, who’ve been picking up this employee’s work for months, have been making snarky remarks about it – implying that management and partners aren’t doing anything about it. I need to bring this situation to a close, but how?

This is always a hard balance to strike as confidentiality is really important. You’re not at liberty to discuss what management processes have occurred as the employee has the right to have that information remain private. However, you can assure staff that you’re following your policy but that you’re not at liberty to discuss the details. When staff show frustration at having to cover, I ask them to consider that they wouldn’t like to be in the position of the person off sick, and if it were them, they’d hope their colleagues had their back too. I’d then look to address anything they’ve found themselves struggling with and see if there was anything I could do to support them. Sometimes, just getting staff to try and put themselves in the other person’s shoes can really help.

I have a member of staff on long-term sick who will not attend meetings when invited to look at returning to work. She has been off for 18 months now with anxiety.

I hate it when this happens because it does feel really hard to manage. However, sickness management meetings are part of your policy, and adhering to policy is part of the contract of employment. Have you tried to offer to hold meetings elsewhere – virtually, at her home or in a neutral location? Do they have a union rep you can speak to or who can represent her? Have you made adjustments to who she can bring with her for support – so perhaps allowing a family member, if she’s not in a union, instead of a colleague?

Has she been to Occ Health? Have you specifically asked them the question, “Is she well enough to attend meetings? And if not, what can be done to facilitate these?” Occ Health will not expect you to allow her to not participate forever; they will try to work with her to find a way to make this happen. If she continues to refuse despite their suggestions, then you just have to move on with your process. Tell her the meetings will be held in her absence and the outcome confirmed in writing. If there’s no prospect of a return to work in the foreseeable future (and, in my opinion, you’ve given it long enough), then you’ll have no option but to dismiss on ill health grounds. As long as you’ve documented all your attempts at support, she’ll have a hard time trying to prove that you’ve not been reasonable.

We have a member of staff who’s been off sick since Christmas, following a miscarriage, then a number of other illnesses, then had Covid, so had to isolate as per our guidelines, now is back in hospital so has not been at the practice at all. An Occupational Health referral was done last year as she suffers from Long Covid and has had a period off work for exacerbation of asthma. However, her health is not improving and she’s having more sustained periods off work. What can be done to support her, or do we need to look for potential dismissal under medical grounds, bearing in mind her asthma has been deemed a protected health condition under the Equality Act? However, her absence is having a massive impact on the team and, subsequently, patient care.

First, let’s get something straight – having a condition that falls under the disability provisions of the Equality Act does not make you immune from being dismissed for sickness absence. Yes, you have to make reasonable adjustments – so you’d set different sickness targets for someone with a disability, but they do not need to be endless. You still have a business to run – a business that’s publicly funded, and we have a duty to ensure the best value for money for the taxpayer. So don’t let that deter you from managing this.

It sounds, however, as if this falls under your persistent absence parameters rather than long-term sickness. Were she to stay off sick for one episode for a prolonged and unsustainable period, then you’d be looking to dismiss on health grounds. However, this sounds more like there are a large number of episodes of sickness, some long and some short. So, you’d need to look at your process for managing these – and you may well find that even with adjusted targets, she’ll still keep triggering and get to the stage where you’re considering dismissal based on attendance.

In terms of how to support her to attend work, that should also be covered in the management process. Have Occupational Health suggested anything you can implement? Can she suggest anything that would help her improve her attendance? There is an HR Masterclass Module on Managing Short-Term and Persistent Absence that I’d recommend taking a look at.

A member of staff has been off sick for six months as her husband has a life-threatening illness and is deteriorating. She doesn’t want to leave him alone whilst at work, and the sick notes say, “stress at home”. We’ve been very supportive and want to continue to support her, but we’re having to pay for locum cover whilst she’s off. This is a delicate situation. What are our options, please?

This is tricky, as the GP is signing her off so it’s very hard for you not to treat it as sickness when you know the reason why. First of all, compassion is key here – what a horrible situation to find yourself in and you have an opportunity here to be a real support to this employee. But you’re right; it does have an impact on the business.

I assume, after six months, her sick pay entitlement is now being impacted? I would be looking to meet her to explain this and what the normal process for managing long-term sickness is but highlighting that you understand her situation and that you’re not wanting to go down this path. However, obviously, it has an impact on the business, so what other options can you look at here?

Given the impact this will have on her pay, I’d ask her whether she was receiving any other kind of financial support. Can she claim a carer’s allowance or get any other sort of financial aid? It’s always a good idea to offer any support you can, even if it’s just signposting to services that she might not be aware of.

I’d then talk about possible options. Given that your normal process would be to dismiss on health grounds, which you don’t want to do, can you agree to a period of unpaid leave/career break whilst all this is going on – subject to regular review? Whilst she’s still in contract and off sick, you’re unable to obtain proper cover, and it’s ok to highlight that this is impacting on your service, provided you can do so sensitively. Taking this option would allow you to recruit someone on a fixed-term contract to cover the role in her absence but would keep her job open for her to return to.

You never know, just by broaching the subject, she might ask to resign or retire because she just may not want to think about it right now. And if her pay is being impacted, it might prove to be the catalyst to start the discussion – that’s been my experience in the past. If she does choose to leave, ensure that the terms of her leaving are positive; she should be offered a leaving do, be given a card/gift/collection and receive all the same fanfare as anyone else. The circumstances aren’t ideal but sometimes people in these situations need a bit of normality in that way.

If you’re already being supportive, you’re halfway there. Having these conversations can be difficult, but if done in the right way, they can mean a positive outcome for all parties involved. I once had to discuss terminating the employment of a hospital nurse with terminal cancer and it’s probably one of the hardest things I’ve ever done. She was a lovely lady, though, and so nice about it, and she asked us to dismiss her on ill health grounds because she said she’d been so committed to her role that she couldn’t bring herself to quit. She actually thanked us for dismissing her as it took it out of her hands and, as she said, she didn’t have to feel like she’d had to give up.

Staff who are off with long-term mental health and who are also emailing the surgery on a daily basis with worrying allegations – how do we manage them?

Well, this sounds intriguing! But also very stressful, I imagine, for you as a manager. First, I would start by enforcing some boundaries. The sickness management process needs to be very active, so you should be looking to meet with your staff member as soon as you learn it’s a long-term absence, and part of that meeting needs to be about discussing how communication is going to work whilst they’re off.

I’d then say that all communication should go through the line manager. If these emails are coming into a general inbox, or somewhere else, then you need to shut that down straight away. You may even have to refer to your disciplinary process – as in failure to follow a reasonable management request or potentially even breach of confidentiality depending on what’s being said in the emails. You can also block their email address from whichever account the emails are being sent to if they’re inappropriate and confirm to the employee that you have done this and that all communication should go through you.

If an allegation is being made, you need to take this seriously and confirm with the employee whether they’re raising a grievance and then investigate that under your grievance policy. This process can run separately from the sickness management process, so that should continue as normal unless the allegations relate specifically to the sickness management process, in which case I’d seek some HR advice or allocate another manager to deal with that side of things.

Useful resources

Notification of informal absence management meeting (long-term absence) [PLUS]
Notification of final formal absence management meeting (long-term absence)  [PLUS]
Absence – Sickness absence policy (reporting procedures and rules) [PLUS]
Sickness absence informal review [PLUS]
Sickness absence management policy [PLUS]
Sickness absence dismissal – long term [PLUS]
Sickness absence outcome or ongoing long-term [PLUS]
 Occupational Health referral questions guidance for managers [PLUS]
Equality and diversity policy [PLUS]
Sick pay policy [PLUS]
Absence – Phased return to work policy [PLUS]
HR Masterclass – Module 6 – Managing Long-Term Absence
HR Masterclass – Module 5 (Managing Short-Term Sickness Absence)

Future HR Clinics

Managing Grievances – Thursday 20th June at 12pm – Book here

“I want to make a complaint” is never a phrase we relish hearing, and it can be all too jarring to hear it from the mouths of our own staff. But that is essentially what a grievance is – a complaint about the working environment. So how do you as a manager deal with grievances? Should it be informal, or should it be formal? Does it link in with other HR policies you have in place? What do you do when relationships are fraught and grievances are flying in from all sides?! This HR Clinic will focus on how we manage the grievance process, what you as a manager can do to reduce the number of grievances coming in and how you can effectively deal with them when they do.