- A referral asks occupational health to translate someone's health into practical terms: what they can do, what would help, and over what timescale.
- The quality of the report is set by the quality of the questions. Specific, open, work-focused questions get specific, useful answers.
- Consent and transparency are not box-ticking. The employee should see the referral, agree to it, and know they can see the report before it is released.
- Occupational health advises; you decide. The report informs a management decision, it doesn't make one.
A management referral to occupational health is one of the most useful tools an employer has – and one of the most commonly wasted. Done well, it turns a difficult, uncertain situation into clear, work-focused advice you can act on. Done poorly, it produces a vague report that answers questions you didn't need answering and misses the one that mattered. The difference rarely comes down to the clinician. It comes down to how the referral was framed, and how the process was handled with the employee. Get those two things right and occupational health earns its keep every time.
What a referral is actually for
It helps to be clear about what occupational health does, because a lot of unhelpful referrals start from the wrong expectation. Occupational health is an advisory service. Its job is not to diagnose or treat, and not to make your decision for you. It is to give you independent, expert advice on how someone's health affects their ability to do their particular job – and what could be done to support them. ACAS describes an occupational health assessment as a useful addition to a fit note precisely because it is focused on the person's actual role and workplace, rather than their fitness for work in general terms.
That framing matters because it tells you what to ask for. You are not fishing for a diagnosis or a medical history. You are asking practical questions: what can this person manage now, what might they manage with support, what adjustments would help, and what is a realistic timescale?
A referral should read as an offer of support, not the opening move in a capability process. Employees can tell the difference, and it shapes what they bring to the assessment.
Start with a conversation, not a form
The single most important step happens before any form is completed: talk to the employee. ACAS is clear that referrals work best when they are a normal, supportive part of managing people – and warns that many employees perceive a referral as a step towards dismissal rather than an offer of help. That perception, left unaddressed, makes people anxious and less willing to engage, which undermines the whole exercise.
So be open about why you're referring and what you hope it will achieve. Frame it honestly as what it is: paying for expert advice so you can understand how best to support them. Share the referral with the employee before it goes, so they can see exactly what you've written and what you're asking. None of this is only good manners – it builds the trust that makes the assessment more productive, and it is squarely what good practice expects.
Ask the right questions
Occupational health can only work with what you give it. A referral that says "please assess this employee" invites a generic report. A referral that asks specific, open questions gets specific, usable answers.
Open questions – those beginning what, when, which, how – draw out more than a yes/no. And giving context makes the advice sharper. If you've already tried something, say so, or you'll get advice to do the thing you've already done. A question framed as "we've moved this employee to reduced hours and adjusted their targets – what else might help them stay in work?" is far more useful than "is this employee fit to work?".
Medwyn tip
Instead of "Is she fit to work?", ask: "(1) What are her current functional limitations for the key parts of this role? (2) What adjustments would help, and for how long? (3) Is a phased return appropriate – if so, at what pace and with what review points? (4) May the Equality Act apply?" Four focused questions, four answers you can act on.
What to include
A good referral gives the clinician enough to build an accurate picture. As a minimum, include a clear description of the role and its actual demands, any recent changes to the job, the relevant absence record, any fit notes or existing reports, a factual summary of what has led to the referral, any support or adjustments already tried, and your specific questions. The more grounded the referral is in the real work, the more grounded the advice will be.
Consent and the report
Occupational health rests on the employee's consent, and this is where employers most often trip up. A referral is voluntary – you cannot compel someone to attend – and the employee has the right to see the report before it is released to you, and to ask for factual corrections. They can also refuse consent for the report to be shared at all. Their health information is special category data under UK data protection law, so it must be handled carefully and seen only by those who need it.
If an employee does refuse consent, you are not stuck – you simply make your decision on the information you do have, and it's wise to record that consent was declined. But these situations are far rarer when the process has been open from the start, which is the strongest argument for getting the conversation right early.
Good practice
The employee should never be surprised by the report. Good occupational health practice is to discuss the gist with them first, and they retain the right to see it before it reaches you. That transparency protects the employee, the process and, ultimately, your decision.
Use the report well
When the report arrives, remember what it is: advice. It sets out what the clinician recommends; the employment decision remains yours, informed by the needs of the business and your legal obligations. Where an occupational health view and a GP's fit note appear to conflict, the sensible course is to talk it through with the employee and agree a way forward rather than simply picking one.
One duty does carry weight. Where the report identifies that an employee is likely disabled under the Equality Act, the obligation to consider reasonable adjustments is engaged – and a report recommending adjustments that is then ignored is difficult to defend. The report is there to help you act, not to sit in a file.
Before you send a referral
- You've spoken to the employee and explained the purpose and the benefit.
- They've seen the referral and had the chance to correct factual errors.
- Consent is recorded, and they know they can see the report before release.
- You've included the role, its demands, the absence record and anything already tried.
- Your questions are open, specific and about the work – not a request for a diagnosis.
Handled this way, a referral stops being a piece of process and becomes what it should be: a fast route to clear, expert advice that helps you keep good people in work.
If you'd like to make occupational health referrals a smooth, trusted part of how you support your team, our clinical team can help – from a single management referral to advice on reasonable adjustments and mental health support.
This article is general guidance for employers and is not individual medical or legal advice. If you are unsure how it applies to your organisation, contact our team.