Occupational health referrals: when, how and what happens
The six triggers that genuinely warrant a referral, the three situations where it's the wrong move, and the conversation that should always come first.
Refer to occupational health when a health question is affecting work and you can't answer it yourself - not because someone has been off, and not to build a file. The usual triggers are long-term absence, repeated short absences with a health cause, a fit note suggesting adjustments, a disability disclosure, a return after serious illness, and work-related stress. OH gives advice; the decision stays with you. And before you refer, you should have already asked the employee what would help.
What is an occupational health referral?
It's a request from an employer to a qualified occupational health professional - usually an OH physician or OH nurse adviser - asking for advice on the relationship between someone's health and their job. The output is a report answering the questions you asked: is the person fit for their role, what would help, what's the likely timescale.
It is not a second opinion on the diagnosis, it isn't a fitness test, and it doesn't have the last word. Acas's guidance on returning to work after absence puts it simply: for sick leave, employers may “consider a referral to a medical service such as occupational health”. It is one input, in a decision that remains yours.
When should you refer someone to occupational health?
The honest test is whether you have a specific question you can't answer. If you can write down the question, a referral will probably be useful. If all you can write is “please advise”, you're not ready - see the occupational health referral letter template for what a good question looks like.
These are the six situations that come up most:
| Trigger | Typical timing | The question for OH |
|---|---|---|
| Long-term absence | around 4 weeks continuous, or earlier if the prognosis is unclear | is a return foreseeable, and on what timescale and terms? |
| Repeated short absences | when a trigger point is reached and there's a health thread | is there an underlying condition linking these absences? |
| Fit note says “may be fit for work” | when the suggestion is unclear or you can't accommodate it | what does this adjustment need to look like in this job? |
| Disability disclosed or adjustments requested | as soon as the request lands | what functional limits apply, and what would remove the disadvantage? |
| Return after serious illness or surgery | before the return date, not after | which duties are safe now, and what should build back when? |
| Work-related stress | at the first sign, not at week six | what work factors are contributing, and what would change that? |
Two of these deserve a note. On disability, Acas's guidance on disability-related absence says the employer “could consider getting medical advice, for example an occupational health report, to help them decide what adjustments to make”. That's the right framing: OH helps you decide, it doesn't decide.
On work-related stress, a referral is not a substitute for looking at the work. The HSE Management Standards cover six areas of work design - demands, control, support, relationships, role and change - and if the answer lies in one of those, no OH report will fix it for you. Pair the referral with a stress risk assessment.
Does an employer have to follow occupational health advice?
No. OH is advisory. The gov.uk fit note guidance for employers and line managers says it plainly: “It is your decision whether to act on this advice and in some cases, you may be able to support your employee without needing additional expertise.”
But advisory doesn't mean ignorable. If you commission expert advice and then depart from it without a reasoned explanation, that's evidence against you in a tribunal - you asked, you were told, you did the opposite. The safe position is to record why.
The obligation runs both ways. In Gallop v Newport City Council [2013] EWCA Civ 1583 the Court of Appeal held that on the question of whether someone is disabled, “the employer must not forget that it is still he, the employer, who has to make the factual judgment as to whether the employee is or is not disabled: he cannot simply rubber stamp the adviser's opinion that he is not.” An unreasoned “not disabled” from OH is not a defence. Ask for the facts - what the impairment stops the person doing, and for how long - and reach your own conclusion.
When should you not refer to occupational health?
- When it's conduct, not health. A referral won't resolve a performance or behaviour problem, and routing one through OH muddies both. See capability vs conduct.
- When it's a short, self-certified absence. A week off with a virus needs a return-to-work chat, not a clinical assessment.
- When you haven't asked the employee yet. The gov.uk guidance is explicit that health and work discussions “should be interactive as the employee is best placed to determine how their symptoms affect their ability to perform certain tasks”. Skipping that step and going straight to OH reads as procedural, not supportive.
- When you already know the answer. If the fit note says reduced hours for four weeks and you can do reduced hours for four weeks, do it. A referral that only delays an adjustment you could have made anyway is a delay you'll have to justify.
- As leverage. A referral sent to signal that things are getting serious is the fastest way to lose the employee's cooperation - and their consent, which you need.
What should you do before making a referral?
- Talk to the person. Ask what's changed, what they're finding hard, and what they think would help. Most useful referrals start here.
- Read the fit note properly. The four suggestions and what they oblige you to do are covered in the fit note employer guide.
- Try the obvious adjustment. If it works, you may not need a referral at all - and if it doesn't, you now have something concrete to tell OH.
- Assemble the facts. Absence dates, the actual demands of the job, and what you have already tried. Guesswork in, guesswork out.
- Explain it to the employee. What OH is, what you'll ask, who sees the report, and that they can see it too. Then get their consent.
Do you need the employee's consent to refer them?
In practice, yes. Faculty of Occupational Medicine guidance for occupational physicians is that consent is required for an OH assessment: the individual “should be informed about the purpose and nature of the assessment and give their informed consent to the process and the preparation of any report”, and may withdraw that consent at any stage. The same guidance notes that if people don't agree to be referred, “forcing them to submit is neither ethical nor practical”.
Health information is also special category data under Article 9 of the UK GDPR, so the report needs a lawful basis, restricted access and a defined retention period - not a manager's inbox. What happens when someone says no is covered in can an employee refuse an occupational health referral, and the limits of what you're allowed to ask in what an employer can ask occupational health.
Where repeated short absences are the pattern, start with sickness trigger points and the Bradford Factor - and remember what has to be excluded from it. When the referral comes back, the next step is usually a sickness absence review meeting and a phased return plan.
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CoDash keeps absence records, fit notes and occupational health correspondence on one timeline - with the review dates prompted before they pass.