Referral Information and Guidance
Where there are concerns that work could be affecting a member of staff’s health or that a health problem could be affecting an employee’s ability to do their job, a referral to OH for advice and assistance in managing such concerns effectively, should be made.
The purpose of a referral to an occupational health practitioner [doctor or nurse] is to provide advice and support to the employee and where agreed with the employee, their managers.
This may be done by:
- management referral
- self-referral
- on offer referral for new employees
Management referral
- Purpose of referral
- When to refer
- How to make a referral
- Making the appointment
- The assessment appointment
- Consent and confidentiality
- Reports to management
- Rehabilitation plan
- Time frames
- Missed appointments
- Employee information leaflet
An individual may be referred to occupational health (OH) where there is concern about their health, performance (where there may be health implications) or level of sickness absence. An assessment by an OH practitioner (doctor or nurse) can provide objective information that can assist management in addressing these issues.
Referral for OH advice can be made for the following reasons:
Advice for supporting individuals experiencing health issues
There is concern that there are work related health problems or that an individual's health is being aggravated by work tasks
There are difficulties coping on return after being absent eg, following a serious illness or injury or due to a disability
There may be underlying ill health or disability contributing to performance issues
There is long term or frequent sickness absence.
If you are unsure whether a referral is appropriate please contact OH for further advice. In addition, the referral may be discussed with or initiated by the Human Resource Schools Team for your department.
Following discussion with the individual, the originator of the request must complete a management referral form containing full details of the individual, their job description, an outline of the problem and the matters on which opinion is sought.
To get the best advice from OH, the referral will need to include enough detail for an appropriate assessment to be made. This will help the clinician understand the nature of the individual's work, advise whether any aspects might be affecting their health and consider any modifications or adjustments which may enable the individual to do their job.
The information should include:
the reasons for the referral
the specific questions to be answered
the individual’s previous two years attendance record
current job description - PD33
any relevant risk assessments (e.g., DSE, individual stress tool, pregnancy)
The management referral form has been designed to assist management in providing the information necessary to carry out a medical assessment and communicate the required information back to management with a copy to the individual and where appropriate the individual’s GP and/or treating specialist.
On receipt of the completed management referral form the earliest available appointment will be sent to the individual as indicated on the referral form and copied to the referrer. If this appointment is inconvenient this will be changed to a suitable alternative.
An initial assessment usually lasts about 45 minutes and aims to collect sufficient information to provide an accurate, objective and useful opinion regarding fitness to perform the job.
The individual will be asked about
The health problem or disability and any concerns that they have as well as any treatment that they may be receiving
The work that they undertake and any difficulties arising from health or other reasons
Any activities out of work that they are involved with
In some instances it may be necessary to request further information from the individual’s general practitioner (GP) and / or hospital specialist. If this is the case the reason will be explained to the individual and they will be asked to sign a consent form allowing OH to approach their GP and / or hospital specialist for this information. Under the Access to Medical Reports Act 1988 the individual has a right to see this report before it is sent to OH. Sometimes and with consent, the OH professional may write to the individual’s GP giving information about the outcome of the OH assessment. This can be particularly helpful where there are clinical findings or work arrangements that the OH professional believes the GP should be informed of.
The individual may be referred for therapy that would facilitate a return to work e.g., physiotherapy and it may be necessary to review the individual to assess their progress as well as any medical reports received, before a firm opinion can be made about any return to work or to full duties.
The reason for the referral must be discussed with the individual and where possible their signed consent obtained - see section 10 of the Management Referral Form.
If it is not possible for the individual to sign the form, but they have agreed to the referral, e.g., if they are absent from work, a copy should be sent to the individual at the same time as confidentially forwarding it to OH.
Discussion and agreement with the individual regarding who else may require access to the OH report once received should take place prior to the referral being sent.
The report should be stored securely within the department and with the Schools HR Team in line with the Data Protection Act: https://www.information-compliance.admin.cam.ac.uk/data-protection . If there are any concerns regarding this please contact OH or your HR Schools Team for further advice.
In line with the General Medical Council guidance [http://www.gmc-uk.org/guidance/ethical_guidance/30665.asp] prior to the report being issued, the individual will be offered the opportunity to view a draft copy of the management report. Further consent will be obtained from the individual by the OH practitioner and that consent can be withdrawn at any stage of the process. If the individual feels that the report contains incorrect factual information this should be highlighted to the OH practitioner. If the individual feels that the OH practitioner’s opinion is incorrect this is unlikely to be amended and the individual may withdraw consent to the report being issued, in which case the OH practitioner will inform the referrer that consent has been withdrawn or agree to the report being issued unchanged.
OH records are maintained to the same high standard of confidentiality as hospital or GP medical records, in accordance with the Data Protection Act (DPA) 1998. An individual’s OH record will not be disclosed to anyone else outside OH without the individual’s informed consent. For full details of how personal information is used by the University Occupational Health Service, please see http://www.oh.admin.cam.ac.uk/general-information/confidentiality-statement
OH reports are advisory only. The content of a report will depend on the reason for the referral, the specific questions that have been asked and any necessary specific recommendations. Medical details are not usually disclosed unless this is deemed necessary when managing the individual in their work and when the individual has given their informed consent for disclosure.
Information provided may cover
Whether the individual has an underlying health condition or disability that may affect attendance or performance at work
If so, the likely effects on future attendance / performance
Measures to support the individual during their absence
Whether time off work will be required for appointments / treatments
When the individual may be likely to return to work
Recommendations on how to assist over a return to work
Advice regarding any workplace restrictions / adaptations
Whether the disability provision of the Equality Act is likely to apply
Copies of the report will be sent to the individuals named on the management referral form only. This is likely to be the referrer, the individual and where indicated the relevant HR contact. The OH practitioner may recommend a copy of the report is sent to the individuals GP and / or Specialist for information
A rehabilitation and / or phased return to work plan may be recommended by OH to allow the member of staff to gradually build up to their contracted duties. This can be beneficial to the individual returning to work after certain illnesses and can also facilitate an earlier return to work.
Recommendations for a phased return may include
Amended duties and / or temporary redeployment
Reduced working hours
Assistance with some tasks, especially if physically demanding
Temporary restrictions on tasks undertaken
A combination of the above
Where indicated a workplace visit may be advised to ensure that recommendations are appropriate and can be accommodated. The individual will be reviewed regularly during this period.
Initial appointment
The referred individual will usually be contacted within 10 working days of receiving the referral form (allowing for all mail deliveries), and an appointment offered within 30 working days.
Report
This will be sent within 10-14 working days of the appointment. Where relevant, an initial report will advise whether further information is being sought from a GP / hospital specialist.
If an individual wants to see a copy of the management report prior to it being sent to the referrer, they will be given 5 days to see the report and confirm it can be sent to the referrer.
If an individual wants to see a copy of the management report prior to it being sent to the referrer, they will be given 5 days to see the report and confirm it can be sent to the referrer. If an individual subsequently withdraws their consent to release the report to the referrer, OH will be unable to issue the report. In such circumstances, managers may seek further advice about managing the case from HR, using the information available to them.
Once a report has been received it should be discussed with the individual. Other managers / HR contacts should not have be given access to the report without the individual's consent. If there are any questions about the report please contact the occupational health practitioner initiating the report in the first instance or if unavailable the occupational health manager. If seeking advice via email do not include any confidential information about the individual in the subject line, and do not forward to anyone without the individual's consent. Please note that the OH practitioner can clarify the report and advice given verbally, but will not answer any new or additional questions without first consulting with the individual. A record of this discussion will be documented in the individuals OH record.
Should the individual fail to attend an appointment then an alternative will be offered and the referrer will be informed. If they fail to attend a second time the referrer will be informed but no further appointment offered. OH should be contacted if further advice is required.
Further information
The following leaflet gives important information about the management referral process for individuals Occupational health referral – employee information
Self-referral
If you are experiencing difficulties impacting your health at work, you can self-refer for advice, but a self referral does not result in a written report to an individual’s supervisor / department. If written recommendations from OH are required a management referral should be completed.
To arrange an appointment a self-referral form should be completed and sent confidentially to the Occupational Health. On receipt of the completed self-referral form the earliest available appointment will be sent to the employee and if inconvenient changed to a suitable alternative.
Please note changes to the Self-referral process from 22 January 2024
As a result of increased service demands and to optimise Occupational Health (OH) resources and appointment availability, from 22 January 2024, OH will only accept referrals for musculo-skeletal health issues relating to Display Screen Equipment (DSE) / computer work set up issues via the management referral route (see above).
The rational for implementing this change is that the self-referral route does not result in a written report to an individual’s supervisor / department, which is often required and may be necessary following assessment. Therefore, in order to provide written recommendations to a department regarding work adjustments or additional modifications, a management referral is required. This will reduce the requirement for a further appointment to be arranged following self-referral and avoids duplication (of advice given).
As part of the referral process where a referral relates to computer use, a workstation risk assessment should be undertaken and the outcome initially reviewed with the Department Safety Officer. This is to ensure the workstation meets minimum requirements* and consideration is given to any adjustments that can be implemented at a local departmental level.
Please read the University’s guidance on Computer Health before completion of the DSE Screen Equipment Self-Assessment Checklist of the workstation(s).
Further general information about laptop and desktop computer set-ups can be found at:
*Minimum equipment requirements for workstations include:
Display screen
Keyboard
Work desk or work surface
A document holder, should this be required
Work chair (standard ergonomic chairs can be supplied with additional features [if needed], such as adjustable seat slide and lumbar support, to enable adjustments to suit most individual needs and requirements)
A footrest, should this be required
Occupational Health always advise that workstations are initially set-up to meet these minimum requirements (standard desk or work surface and good posture / set-up) before recommendations are made for alternative / additional equipment. To optimise musculoskeletal health, regular rest breaks (including mini rest breaks every 15-20 minutes) are also required to reduce prolonged static postures. Rest break software, such as www.workrave.org, can be helpful to prompt these breaks. Stretching exercises may also be helpful.
With regards to the provision of height adjustable desks, it is a local decision as to whether this equipment is provided in addition to the DSE standard equipment. Whilst height adjustable desks can be helpful in some circumstances whereby an individual may need to easily adjust their posture when working, in many instances this can be achieved through regular postural breaks.
If following the DSE assessment, health concerns are identified and OH advice is required, please do arrange to complete a management referral and forward a copy of the DSE risk assessment along with the action taken to date to Occhealth@admin.cam.ac.uk On receipt an appointment will be allocated accordingly.
On-offer referral
The purpose of an on-offer referral to OH is to enable new employees and those undertaking studentships or their managers/supervisors to seek medical advice or support from Occupational Health, where necessary, when accommodating a new employee with a health condition or disability. Explicit consent from the individual concerned must be obtained before making a referral using the ‘on offer’ referral form.
Please see HR recruitment guidance for information about the on-offer referral process.