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Top tips for managing absence – Part 3 of 3: Occupational Health referrals

by in Absence, HR - Human Resources

Top tips for managing absenceIn this final absence-related blog, I’m going to look at making the most of Occupational Health referrals and implementing reasonable adjustments.

Occupational Health

Sometimes it might seem that Occupational Health is a pointless and expensive exercise. But an Occupational Health report is only as good as the referral you make. The purpose of Occupational Health is to consider the employee’s health in the context of their employment. They’re not there to diagnose conditions, recommend treatment or provide medical intervention. Their sole purpose is to consider the employee’s health condition in terms of how it’s impacted by, or contributes to, their work.

Seeking Occupational Health’s opinion is imperative if there’s even the slightest possibility that the employee’s contract may end – either by dismissal or resignation. You don’t want to end up in an employment tribunal and not be able to demonstrate that you took professional advice from an Occupational Health physician. Their report should form the basis of any decision you make regarding the employee’s future with your organisation. Employees have successfully claimed constructive dismissal at tribunal because the employer hadn’t consulted Occupational Health and hadn’t considered reasonable adjustments. If your practice partners don’t want to fork out for a referral, it might be worth reminding them that compensation awards for disability discrimination are uncapped!

When should we consider a referral to Occupational Health?

There’s no set formula, but I always advise a referral when:

  • The employee has been off sick for four weeks or more
  • They are absent due to stress
  • They’ve had persistently high sickness rates within a 12-month period
  • They’re returning to work following surgery or treatment that may affect their ability to complete their role
  • You have a concern about their performance/behaviour/conduct that you feel is out of the ordinary and may impact on their ability to carry out their role
  • They’re undergoing other formal action (e.g. performance management, disciplinary, organisational change, etc.) and you’re concerned this may impact their health

The employee may refuse the referral, and if they don’t consent you can’t send it. In these circumstances, document their refusal. But it’s also worth explaining to them that the role of Occupational Health is a supportive one and enables you to fully support the employee in their role in light of any medical conditions they may have. Practice Index has a good Occupational Health policy [PLUS] which you can share with your staff to explain the purpose of the service.

What sort of questions should I be asking?

Remember that a good Occupational Health provider will use your referral as a guide. They’re relying on you to provide them with relevant information (details of the employee and their job, a copy of the job description, and information relating to the reason for the referral) and to ask the questions you want answered.

Depending on the reason for the referral, the questions may vary.

For a staff member on long-term sickness absence, you may want to ask:

  • Is the employee likely to be able to return to their current role in the foreseeable future (e.g. 6-8 weeks)?
  • If yes, are there any adjustments we need to make to support a return work (e.g. phased return, changes to shift pattern, amended duties)?
  • Are there likely to be further absences related to this condition? If so, do we need to consider any adjustments in managing their absence going forward?
  • Are there any adjustments we can make to the workplace to support the employee (e.g. special equipment)?
  • If they’re unable to return to work in the foreseeable future, would you recommend redeployment to another role? If so, what sort of role should we consider?
  • Would you support an application for ill health retirement?
  • Would you consider this issue to be covered under the disability provisions of the Equality Act 2010?

You don’t need to include all of these questions as standard, just pick the most appropriate. You can also add any other questions you feel are relevant. For example, if an employee has been off with a broken leg and you’ve planned for them to do some non-clinical work on their return, you can include this suggestion in the referral and ask the reviewing physician if they support the plan.

For a staff member with persistent short-term absences largely related to the same condition, you may want to ask:

  • Can we expect this level of absence to continue?
  • Are there any adjustments the department can make to support the employee in maintaining their attendance (e.g. special equipment, amended duties, etc.)?
  • Would you class this condition as being covered by the disability provisions of the Equality Act 2010?
  • Should we allow some leeway in managing this condition going forward (i.e. changes to trigger points on the policy)? (Disregard this if you already have an adjustment in place, but include it in the introductory section of the referral so that the physician is aware.)
  • Is there anything we can offer the employee to support them (e.g. time off for appointments, employee assistance programme if you have one)?
  • If this level of absence is likely to persist, should the employee consider a change to their terms and conditions of employment (e.g. a reduction in hours, change of shift pattern, change to role) if the practice can accommodate this?

For a staff member with persistent short-term absences with no underlying health reason, you may want to ask:

  • Is there any underlying health condition we’re not aware of that may be impacting their attendance? If there is, do we need to consider applying any adjustments in terms of managing their attendance?
  • Is there anything we can do to help them improve their attendance levels?
  • Is there any advice you can offer on improving their general health and well-being?
  • Can we expect the level of absence to improve over time?

What do we do once we receive the report?

The report is likely to contain recommendations to help you manage the employee’s absence/health/performance. If you’re unclear about any part of the report or advice given, you should ask the sender to clarify their comments.

It’s imperative that you meet the employee to discuss the report and you acknowledge the recommendations. If you’re able to accommodate the recommendations, tell the employee you’ll do so, and confirm whether this will be on a temporary or permanent basis. If you’re unable to accommodate them, explain why to the employee and discuss possible alternatives, if available, or other options.

It’s imperative that you acknowledge the recommendations and if unable to implement them, justify why not.

Many organisations have been penalised at tribunal for failing to heed Occupational Health’s advice and/or to implement reasonable adjustments.

Reasonable Adjustments

So what are “reasonable adjustments”?

Employing organisations are legally obliged to implement reasonable adjustments for employees with protected characteristics under the Equality Act 2010. In general terms, this applies mostly to disability, maternity and religion but here we focus mainly on disability.

What constitutes “reasonable” will vary according to the organisation. For example, installing automatic doors for disabled access may be reasonable for an organisation that can afford to do so, but may not be reasonable for a small enterprise or voluntary organisation.

The nature of the business will also be taken into consideration – and this is where the NHS gets hit hard. The aim of the NHS is to provide medical care and promote the positive health and well-being of the nation’s population. Therefore, the NHS as an employer faces an even greater responsibility to do the same for its employees. Tribunals expect the NHS to almost bend over backwards to provide adjustments and support for employees with health problems.

However, this doesn’t mean we must always say yes. The key thing to remember is that you must have a justifiable reason for saying no. For example, it wouldn’t be reasonable for the sole practice nurse in a small GP practice to stop changing patients’ dressings if he/she were the only practitioner able to do so and there was no money in the budget to recruit another nurse.

So what kind of reasonable adjustments might we consider?

The list below contains some examples but it’s not exhaustive. All adjustments should be reviewed regularly. I’d avoid making anything “permanent” as situations change.

  • Change to working environment (equipment, room, lighting, desk, chair, temperature, noise levels, etc.)
  • Change to working hours (contracted hours, shift patterns, flexible working arrangements, etc.)
  • Change to duties (removal of manual handling, tasks taken away or amended, temporary or permanent redeployment, etc.)
  • Change to attendance targets (i.e. more episodes/days off/higher Bradford Factor threshold before trigger point reached)
  • Phased return to work after long-term absence*
  • Period of time shadowing/being mentored by another staff member
  • Additional training/refresher training to be arranged
  • Relaxed KPIs/targets for a set period (compared to other staff)
  • Provision of specialist equipment (ergonomic keyboard/mouse, dictation software, anti-glare screens, contribution towards the cost of glasses, etc.)
  • Provision of counselling/therapies/external workstation assessment paid for by the practice

*Phased return to work: I’d ALWAYS recommend offering this to an employee who’s been on long-term sickness leave and I’d ALWAYS recommend paying them for their normal contractual hours during it. In my experience, paying a reduced salary to a staff member for a phased return just means they stay off sick – especially if they still have full occupational sick pay. Paying full salary is a massive sign of goodwill and shows appreciation and care towards the employee. This goodwill will often be reciprocated in time.

In terms of how it should work, I’d never recommend that an employee returns on less than 50% of their contracted hours. In my opinion, if they can’t do half they’re not well enough to return at all. (This also protects you from paying them full salary for doing an itty-bitty number of hours.) The phased return should last no longer than four weeks in total. If they’re unable to maintain their full contractual hours after four weeks, you should consider either a temporary or permanent reduction in hours (with the associated pay cut).


Even if you’re having an off-the-cuff discussion with an employee about a disability and/or a reasonable adjustment you intend to implement, document it! Practice Index has a template “Reasonable Adjustments Agreement” form [PLUS] you can use to document what the health issue is and what you’ve agreed to put in place to support the employee.

I hope you’ve found this series of blogs on managing absence useful. If you have any requests for other HR-related topics to be covered, please comment below!

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Robyn Jackson
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