Employees are often suspicious when occupational health (OH) asks for GP or specialist reports, thinking that they are being checked up on—or worse, not telling the truth about their health.
OH will ask for a GP or specialist report for a variety of reasons, such as:
- Asking a doctor for confirmation of the medical condition
- Investigating the progress of illness
- Confirming facts about a medical situation
- Informing the GP about a work situation relating to an employee’s health and asking advice
- Discussing ill-health retirement reasons
- Investigations before starting work, especially in jobs such as working with children or vulnerable adults
- Fulfilling a procedural requirement prior to a business taking action (e.g., dismissal)
GPs and specialists will not release any information unless their patient has given permission for the information to be shared.
This is called giving consent, which is a legal need to get access to health details; remember that the employee cannot be forced to give consent.
Consent Process for GP or Specialist Report
The consent process is covered by law (Access to Medical Reports Act) and steeped in medico-legal tradition and practice.
The act states:
It shall be the right of an individual to have access, in accordance with the provisions of this Act, to any medical report relating to the individual which is to be, or has been, supplied by a medical practitioner for employment purposes or insurance purposes.
All health professionals value and uphold the consent process.
The Data Protection Act (DPA) controls how personal information is used by organisations, businesses or the government. Everyone who is responsible for using data has to follow strict rules called “data protection principles”. They must make sure the information is:
- Used fairly and lawfully
- Used for limited, specifically stated purposes
- Used in a way that is adequate, relevant and not excessive
- Kept for no longer than is necessary
- Handled according to individuals’ data protection rights
- Kept safe and secure
- Not transferred outside the UK without adequate protection
There is stronger legal protection for more sensitive information, such as health records.
In my experience, the facts of the DPA are barely understood by most. Therefore OH doctors and nurses go to great lengths to make sure that the consent process is legally sound and explained to the worker.
For more information about the consent process and to see a typical form and GP letter: click here
GP or specialist reports take ages to come back and can cost a lot, which is why asking for a GP or specialist report must be for very good reasons. Some GP and specialist reports I’ve requested haven taken over six months to arrive.
Meanwhile, the employee and management wait, with me phoning the surgery/clinic every couple of days to hurry it along, unable to move on or go back until we have the report.
Difference between GP and Specialist Reports
- A general practitioner (GP) is the family doctor and keeps a record of all health matters from cradle to grave. GPs are in charge of referrals and treatments, keep all the health records together and coordinate treatment.
- The GP gives individual advice; if more investigations or help are needed, then the GP refers patients to a specialist. There may be many specialists for a worker, but only one GP.
- Specialists deal with a particular type of health issues, such as the heart, the lungs, the kidneys, the skin or mental health, and are usually hospital based. They have a looser relationship with the person than the GP.
- The GP and specialist work together, providing a team approach to the worker.
- In my experience, when providing reports, GPs are quicker returning the report than specialists, but specialists tend to be more factual about health conditions.
- If there is a situation where the GP may compromise the patient’s account of a situation, it may be better to request a copy of the notes rather than a report written by the GP.
- GP reports are generally cheaper than specialist reports.
Questions to Ask:
Typical questions asked in a GP or specialist report:
- When is the person expected to return to work?
- What can we do to help improve attendance?
- Are there any long-term health conditions that could be covered by the Equality Act?
- Can we have a copy of your health file?
Many times, individuals are checking some detail that is under dispute that could result in serious action—e.g., confirming medication side effects or compliance with addiction therapy.
Receiving the GP or Specialist Report in OH
Hopefully the GP or specialist answers all the questions that are asked, but in 50% of cases, some of the questions are missed.
Although workers have the right to change the report, rarely have I seen statements added by patients who are in disagreement with their GP or specialist; in fact, I don’t think I’ve ever seen one.
Upon receipt of the report, the OH professional will take the following action:
- Let management know that the report has arrived and send the invoice to management for payment. This can vary in price from free to £3000 or anything in between.
- Decide on the likely course of action and make recommendations to management.
Can a Manager Overrule a GP Fit Note?
One thing to remember is that GP and specialist reports are not binding on the employer— and they have the right to override what the GP or specialist suggests, taking into account the needs of your business.
Guidance from the Department of Health gives this advice to employers:
The assessment about whether your employee is not fit for work or may be fit for work (and any other advice in the fit note) is classed as advice, and it is for employers to determine whether or not to accept it. Occasionally, you may believe that your employee is not fit for work when they have been assessed as fit for work by their doctor, or you may think that your employee could do some work when they have been assessed as ‘not fit for work’ by their doctor….. In situations like this, you as the employer are within your rights to gather other evidence about your employee’s fitness for work from other doctors or healthcare professionals. You can choose to give this other evidence precedence over the advice in the fit note.
Why Not Send GP or Specialist Reports to HR/Management?
Managers and HR do not have medical training. They are unlikely to have a lot of experience with people working or stopping work due to health conditions. Many opinions on health issues are influenced by personal experience, media, prejudice and myths. This is not helped by the fact that people are able to Google health conditions and read extraordinary tales of horror and treatment failures without regard for the impact on others.
This approach has no place when deciding a person’s livelihood and how best to help sick or ill workers. Health issues should be dealt with on an individual basis, using tried and tested methods.
OH professionals know the workplace and the management; they are able to look at the clinical picture, know what is achievable and negotiate a way through this delicate maze for the benefit of the worker and the workplace with minimum disruption.
GPs and specialists know they are writing to fellow health professionals and do so knowing that the reader understands health objectively and without prejudice. This is why the report is not sent directly to HR or management.
Note that managers and HR can request reports from medical professionals (with consent from the individual); however, the received report will be written for a lay person and, as such, may not be as helpful or as comprehensive as a report written to another health professional.
OH Extracts Information
When the report is returned, the OH professional takes relevant facts from the report that help the management of the worker.
For example, a manager will not need to know the blood pressure reading and tablets taken to control it. But he or she will need to know that Mr Smith cannot drive a fork lift truck or drive a bus until the health condition is under control. Some health problems (like blood pressure) are so common that OH professionals suggest sharing the facts with the manager, especially if everybody already knows. After all, some people love to talk about their health—warts and all!
The other problem with the report is that the employee thinks that the GP’s advice is binding on the employer, even though it isn’t. This really doesn’t help a situation, especially if poor health is work related or there are claims of bullying or harassment, and the report can make matters a lot worse.
Most GP and specialist reports clarify a situation, but some can make matters more confusing or prolonged, and some can even create problems. GP and specialist reports are useful to have, but it is just as frustrating when the report hinders rather than helps by being ambiguous or late in returning. These reasons are why GP and specialist reports are not always the best way forward and should only be used when necessary, always taking into account the problems that could occur along the way.
To download a template GP letter and consent form: click here
For full guidance document from the UK Government: Getting the most from the fitnote