5 Steps for the Perfect Management Referral

If you’ve invested in an occupational health (OH) service, you need to use it correctly, or you could be adding to your problems, rather than solving them, especially when using the management referral service. Here are the 5 specific steps for manager referrals in detail and sure success!

Here, not only will you discover 5 steps that will super-charge your manager referral process, but you’ll also discover why they are critical.

This article will save you all the angst of getting unworkable recommendations from occupational health; or if you do, rescue the situation.

I Need To Make a Management Referral

You’ve identified an employee who has a health problem.  You need to figure out what advice you need and why and discuss it with the employee. You fill in the paperwork, attach a job description and await the helpful advice coming your way from occupational health.  What a relief to have a service such as this!

Reports From Occupational Health

One week later you get a report back.  In most cases the report is fine, but sometimes the report makes you so mad you could fling it on the floor and stamp on it. Did you wait a week for this?  Did you fill in all that paperwork for this?

The report is, at best, not helpful, at worse, confused the situation and left you nowhere to go.

It’s worth pointing out here that occupational health has not deliberately set out to annoy you. They think they are helping. I know, I was that soldier….

How Did the Report Come About

Occupational health writes a report after reading your referral form, examining and speaking with the worker, looked at the job description, and occasionally getting a report from the GP or Specialist. They base their suggestions on their experience and training, for helping you manage the worker and the health issue.

The information you put on the referral form is all they have to hear your side of the problem – whereas the worker, is able to talk at length about their situation and health directly with them. Face to face.  You can see who has the advantage here?

Let’s go back and look at how you can prevent poor management referral outcomes:

SLA for occupational health service
SLA for Occupational Health Service

Step 1.  The Occupational Health Contract/Terms of Reference

All services should be set up with a service level agreement (SLA) specifying how the occupational health service will work.  The SLA will also cover the process for reporting back to you.  Many occupational health services have options for discussing a situation with the line manager before committing comments to paper.

This is good practice, especially with complex cases.

It must be absolutely clear from the outset, that in law, it is the manager’s responsibility to make any decisions after the recommendations from occupational health. Occupational health has no responsibility to make employment decisions. The employee needs to know this to prevent any misunderstanding of occupational health’s role in your organisation.

One example of how this is applied is in cases of disability (under the Equality Act).  Although the occupational health doctor or nurse can give an opinion on whether the person is disabled; the decision will always be the employers. See Gallop v Newport City Council

Step 2.  Discussion with the Employee

In most cases, you want to find if a worker can’t or won’t do the job.

This is when you use the management referral service because you need an expert opinion.

What you don’t want to do is to go through the process as a tick box exercise before dismissal or starting the disciplinary process. Everyone sees your motives there. No matter what the recommendations are from occupational health, some managers ignore these totally and go straight to the dismissal.  The management referral to occupational health referral is merely a step along the way.  This results in the management referral process being a waste of time and viewed with suspicion by all workers.

The biggest issue is when the employee and the manager have different versions of the truth. And particularly difficult in cases of bullying, harassment and stress at work.

Although the worker has the opportunity to talk to the OH doctor or nurse; the only information coming from you is on the referral form.

The Referral Form

In my experience, managers write down the bare minimum on the referral form; and leave out relevant facts. I’m not sure if it’s due to time pressures or not knowing what is relevant to the management referral?  In some cases, it might be because the manager does not want to put the full story.  Whatever the reason, it means that the discussions with the worker at occupational health are totally different to what is on the referral form, resulting in the employees explaining the situation, rather than the managers.

Managers, if you want a meaningful report back from occupational health, always write down the relevant facts of the case or be open with the employee about the reasons for referral and questions you want answering.

If you think the case is complex or likely to be hijacked by the employee:

  • Talk to occupational health before the appointment to clarify any contentious issues that could arise.
  • Leave your telephone number and contact details so that discussions can be held during the consultation or before the report is written. Once the report is written it becomes discoverable in law and difficult to remember the circumstances of each case and who said what and when and how.

Step 3.  Receiving the Report

Occupational health discusses and agrees on the final report with the employee during the consultation.  Eighty percent of the time the report will be satisfactory and what you expected; but twenty percent could be contentious.

If you get a bad report,  contact the author of the report immediately and discuss (rationally) how and where the report fails.

Satisfactory Report Received

From the recommendations, you will see the best way to deal with your employee’s health issues. If it’s a rehabilitation or phased return to work programme you will have an outline of progress and checkpoints you need to make.

Unsatisfactory Report Received

The report from occupational health does not deal with the situation and/or the recommendations are unworkable.  You may be angry and disappointed, but you still need to deal with the situation. Take my advice, it is not OH’s intention to cause problems for you or the worker.

Do not discuss the report with the worker at this stage! That will confuse the worker and undermine any good that the management referral might do.

If you disagree with the recommendations, think why:

  • The recommendations are nothing like you expected – they go too far or not far enough?
  • Could you be reacting against somebody trying to control your team?
  • You believe the worker is trying to get one over on you?
  • The occupational health person is incapable of making a business decision and is too soft and fluffy?
  • The report is confusing – you are not sure what to do next?

Step 4. Feed Back and Negotiations

If the report has factual errors or is unhelpful, make an appointment to talk or see the occupational health practitioner and ask for corrections to the inaccuracies. It may be obvious to you, but explain why the recommendations are unworkable and suggest alternatives, built on what’s already been recommended.

You and the occupational health professional must try to reach an agreement.  If you agree, ask they change their recommendation accordingly.

It may be that there are no options possible, so this needs acknowledging too.

Note: although health professionals will not disclose the nature of the illness, it is still possible to discuss capabilities without going into detail of the health issue.

Informing the Employee about Changes

Because the occupational health practitioner has spoken to the employee about the original report and recommendations, they need telling about the changes.

Often managers get upset at this point, believing I am asking the employee if it’s OK to change things? But, it is not about getting the employees agreement; rather explain what happened and the suggested solutions.  It’s all around issues of medical ethics.

Occupational health professionals would quickly lose credibility in your organisation, as word spread, that I said one thing to the worker and another to a manager.

Screenshot_113015_110545_AMStep 5.  Case Conference

If a case has gone pear-shaped or you think it has the potential to do that; call a case conference with OH and thrash out any misunderstandings and before the last report arrives on your desk.

This is where an individual, the occupational health practitioner, trade union or worker representative, HR and manager, discuss the way forward together.  Open meetings prevent misunderstanding and delays with immediate decisions.

In my experience case conferences are rare, but hugely successful.


Managers need a good system of referral, with clear arrangements.  They also need to be transparent and willing to accommodate workers, as well as making decisions of when to draw the line.

Use these 5 steps and it will amaze you how much more useful and efficient the management referral process will be for you and your workers. Plus you will be getting the best from your occupational health service.

If you want some examples of management referrals that have gone good and bad, have a look at my book (The Good, the Bad, and the Smugly, Behind the Scenes in Occupational Health) and you’ll see exactly what I mean.

Further Information

Guidance on the Equality Act

Example of template service level agreement

Management referral and general advice

How to refer to Occupational health (video)

National Fitness for Work service for Employers Information

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