Referral

The purpose of a referral to an occupational health practitioner [doctor or nurse] is to provide advice to the employee, and only with the employees consent to provide relevant information in response to referral questions raised by their managers. 

Management

Self-referral 

Ill-Health Retiral

The role of the Occupational Health Service (OHS)  is advisory, both to the employee and the employer with regard to the impact work has on the employees’ health and welfare, and the effect the employee’s health is having on their abilities to perform their duties satisfactorily. It is neither enforcing nor disciplinary in nature. To this effect, the Service plays an active part in the implementation of the University Sickness Absence Policy. 

Heads of Department/School are reminded to refer to the relevant Human Resources documents regarding disciplinary procedures. 

A-Z HR Policies

Referral for OH advice can be made for the following reasons: 

• Obtaining advice to support 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 anticipated difficulties with coping on return to work following absence e.g. a serious illness or injury or due to a disability 

• There may be underlying ill health contributing to performance issues 

• There is long term or frequent sickness absence. 

If you are unsure whether a referral is appropriate please contact OHS for further advice. In addition, the referral may be discussed with or initiated by the Human Resource Team for your department. 

Following discussion with the individual about the reason for the referral, the originator of the request must complete the relevant Referral form.

The document has been designed to assist management to provide the information necessary to carry out a medical assessment and to communicate the required information back to management with a copy to the individual, HR and where appropriate the individual’s GP and/or treating specialist. It requires full details of the individual, their job description, how they are to be contacted and an outline of the problem and the matters on which opinion is sought. 

Please do not substitute a management referral for a self-referral. You are advised to submit a management referral if advice is being sought with expectation of a response to a manager; a self-referral is a confidential conversation between OHS and the employee and does not generate a response from OHS to management, OHS cannot anticipate what a manager needs to know, there will not be a report or advice provided to a manager from a self-referral.

• 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; suggested questions are in the referral document, the referring manager should ‘tick’ the most appropriate or add their own if relevant and within. reason, bearing in mind this information will be discussed with and be avaible to the employee. They should know the reason for the referral. 

• The individual’s previous two years attendance record. 

• Current job description  and any relevant risk assessments (e.g., DSE, individual stress tool).

Prior to considering the application to be considered for early retirement on the grounds of ill- health (IHR), the individual should be advised to contact both Pensions Department and Human Resources for clarification of the relevant policies and terms of their pension. Usually the individual concerned is unable to work following all considerations relating to work adjustments having been trialled or implemented to include possible redeployment considerations; this information will be required as part of the evidence assessed which will also need be in evidence and available to the Pension provider. The employment implications and potential for unsuccessful application as an outcome will require discussion with Human Resources, the manager concerned and the employee prior to making the referral as effectively the individual will have been deemed as unfit for further work if the application is progressed, albeit that the decision outcome is ultimately for the pension provider and not OHS.

Pensions

Human Resources

This form should only be used to assess if the current health of an employee would appear to meet the criteria of the specific pension provider for ill-health retiral. The employee will be assessed by the Occupational Health Physician (OHP) who is approved by the individual pension schemes to undertake this assessment. The consultation will require the OHP to assess the individual including considering the medical evidence available, and work adjustments that have been considered. Reports will be commissioned from treating Specialists and the employer; and only after this information is obtained will the OHP be able to decide if such an application can be progressed. The OHP opinion will be indicated to the individual concerned and they will then have to consent to all the evidence being presented to their pension provider for their on-going consideration and assessment. The level of award (or not) is then decided by the pension provider and not OHS. 

The person making the referral should ensure the referred employee is aware of the referral and its purpose, they MUST be part of a pension scheme and as it is their pension they must agree to the application being made. The declaration on the form must be signed to confirm this. 

The completed form should be sent in confidence either electronically or by internal mail to the Occupational Health mailbox where it will be passed to the relevant adviser for your area. The employees consent to assessment and provision of all evidence to the pension provider will be obtained by OHS. 

The document is ‘Referral for Assessment of Ill-health leading to Early Retirement on Medical Grounds’.  

http://www.docs.csg.ed.ac.uk/Safety/health/ihr_referral.docx 

http://www.docs.csg.ed.ac.uk/Safety/health/ihr_referral.pdf 

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 and is usually in response to the referral questions. 

The individual will be asked about; 

• The health problem 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 relevant activities out with work. 

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 Occupational Health to approach their GP and / or hospital specialist for this information. The individual has a right to see this report before it is sent to Occupational Health.  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 advised regarding 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 an 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. 

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 can be sent to the individual.  

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.  

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) 2018.  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 OHS, please see :

Confidentiality and Medical Records

Occupational Health 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. The report generated by a referral will be based on the information provided to Occupational Health Service at the time of assessment and the questions on the referral form. (see section on ‘How to make a referral’). 

The report may include the following information: 

• Opinion on fitness for work. 

• Nature of the reported health condition, injury or illness. 

• Expected time frame for recovery and/or return to work. 

• Potential modified duties and/or workplace adjustments. 

• Return to work plan. 

• Recommendations to address any identified issues/barriers. 

• Functional education and guidance on health condition management. 

• Opinion on applicability of Equality Act provisions in terms of; timescales, effect on daily activity, and their effect on functions at work. This will allow for the employer to give consideration to adjustments, although the reasonableness of these is an employer’s decision and will be likely to require some input from HR. 

Following the assessment OHS may recommend further occupational case management/review assessments to help assess progress/recovery and/or return to work. 

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. This report should be stored securely with restricted access according to the consent considerations, whilst also considering the Data Protection Act.  If there are any concerns regarding this, please contact OHS or your HR Schools Team for further advice.  

The University has a duty under the Health and Safety at Work etc. Act 1974, and the Management of Health and Safety at Work Regulations 1992, to protect University employees' health against hazards in the workplace.  

Work related health problems, which may involve exposure to hazardous processes, systems of work, or substances, should be notified via the Health and Safety Department Accident and Incident reporting system:

Accident/Incident Reporting

There are many conditions which may be attributable to occupational activities. Some typical examples of health problems which may be work related include:  

• Dermatitis attributed to glove use or substance used at work 

• Allergy type symptoms including breathlessness attributed to exposure to allergens in the workplace 

• Musculo-skeletal problems attributed to DSE work, microscope work, or pipetting 

• Stress attributed to work causes 

Anyone can report a case of suspected or confirmed Occupational Ill Health Occupational Ill health, reports can also be submitted by using the form in the link below and sending it to Occupational Health Service

Health and Safety - Accident and Ill Health Reporting 

This will usually require notifying your School/Local Safety adviser in the first instance as this may require investigation and involvement of those with the H&S responsibility for the employee concerned. The H&S Department will also be notified of certain accidents, incidents, dangerous occurrences and cases of occupational ill health as these must be reported to the enforcing authorities (primarily the Health and Safety Executive (HSE) under the requirements of the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations, 2013 (RIDDOR). The requirements of these regulations are very specific and the Health and Safety Department will decide which events come within these regulations and will make all necessary reports to the enforcing authority, where appropriate. 

University employees who have not been referred by their School/Unit but who would like advice on a health matter that affects work can self-refer to Occupational Health. Self-referral can be initiated by completing the self-referral form which should be sent in confidence either electronically or by internal mail to the Occupational Health mailbox where it will be passed to the relevant adviser for your area.  Self-referrals do not normally result in written reports to an individual’s supervisor / manager and if written recommendations from OH, are required a management referral should be completed as this should not be as a substitute for management referral.

By contacting OHS, the employee can be given advice about any work aggravated health problem or concern that they may have, or signposted to the most appropriate solution for them. An appointment may not always be required but if made it will be for telephone/in-person or ‘Teams’ confidential consultation with an Occupational Health practitioner. Advice from Occupational Health may include guidance concerning a health issue affecting work, sickness absence, planning a return to work, or guidance regarding requirement for adjustments in the workplace. 

If written recommendations or advice is required from OHS, we would advise a management referral should be completed. A self-referral should not be as a substitute for management referral and will not normally result in written reports to an individual’s supervisor / manager.  It is helpful but not essential that the employee’s manager is aware that advice from OHS is being sought, particularly if it is likely that an adjustment at work needs to be considered to accommodate a health problem, as the manager will determine if these are reasonable.