GP and Specialist Reports in Occupational Health

GP and Specialist Reports Request

Occupational Health professionals can ask for GP and Specialist reports for clarity in health situation especially if there is doubt about a diagnosis when employees are off on long-term sick or where there are issues with mental health and capability.

The Rules regarding Writing for a GP and Specialist Reports

All practising doctors and nurses abide by medical confidentiality rules. This allows workers to talk ‘in medical confidence’ to their occupational health service (although there are some rare exceptions to this.)

The Faculty of Occupational Medicine (2013) writes:

Almost all medical practice depends on the willingness of patients to disclose personal and often sensitive information to the doctor. Patients have a right to expect that information about them will be held in confidence by their doctors. Confidentiality is central to trust between doctors and patients. Without assurances about confidentiality, patients may be reluctant to give doctors the information they need in order to provide good care.

The duty of confidentiality is owed by all doctors including those involved in occupational health. There is legislation relevant to confidentiality, and it includes the Data Protection Act 1998, and the Human Rights Act 1998, with the common law also having an impact. If a patient believes their confidence has been broken unlawfully or unethically they may take action against the doctor through the civil courts and or the GMC.’

Informed Consent

Occupational health (OH) must inform the worker why the manager wants a report and likely outcomes. We call this giving ‘informed consent’.

Different types of processes require different consent, but the basic principle is that individuals having an occupational health assessment are absolutely clear about the process, likely outcomes and what OH reports back to management or third-party (employer, insurer, pension scheme, OH provider, etc.).

The individual gives informed consent when requesting GP and Specialist reports and outlined in the Access to Medical Reports Act .  There are other rights such as seeing a report, correcting errors or even withholding the report from being released (a template consent form and GP letter are available here). Note that people can refuse consent or even change their mind about giving or withholding consent at any time.

Further professional information and guidance is available by the Faculty of Occupational Medicine (December 2012)

The Role of the GP

OH professionals understand both health and the workplace.  People, returning to work need to work safely and the GP may not understand how the law applies. We may have to design a rehabilitation programme of reduced hours/duties for disabled people and comply with the law. So take this into account too.

The Royal College of GP’s defines the role of the GP as: (2011) as:

‘GP’s assess, diagnose, treat and manage illness.  They carry out screening for some cancers and promote general health and wellbeing.  GP’s act as patient’s advocate supporting and representing patients best interests to ensure they receive the best care and most appropriate health and/or social care’.

As you can see there is no mention of the workplace in the definition.  Research shows that work is good for health and that elements of jobs are possible for employees with particular health conditions, but that GP’s may not have the necessary training to understand this.  Consider the various types of industry in your area – a GP would have little knowledge of the opportunities for redeployment in each workplace – yet the OH professional working directly with a company will have intimate knowledge of how to accommodate a return to work programme or what would be available as ‘modified’ duties or even what would be considered a ‘reasonable adjustment’.

What’s Changed?

Employment tribunals do not really understand the role of OH and have often said that if the employee has a hospital specialist, there should be a current report on file from the specialist concerned or a GP, but that this is a matter of judgement see Kloss 2007 summary l So it seems, to be on the safe side, requests for GP/Specialist reports happen more frequently than they should do.

Before writing for a GP/Specialist report consider the following:

1. Why do you want a GP/Specialist report?

What you hope to gain from the report – what value will a report add to the situation? Will the report offer extra information than you cannot gain from an occupational health assessment alone? If not, business wastes both time and money, with both management and employee waiting for an outcome. Some reports can take months to arrive back from the GP/Specialist.

2. For an In-house OH service

The employer should adopt a policy on when to ask for a GP/Specialist report and agreed with Management.  Say for example, if the company policy is that everyone sees an OH physician (OHP) or have a letter from the treating specialist before being dismissed on health grounds, then this must follow or the Tribunal will rule that it should have been and the dismissal was unfair because  the company aren’t following their own internal rules.

I wrote this into OH policy when starting up a new OH service which worked very well.

3. Contracted OH services Process

Contracted OH services have their own service level agreements (SLA) with a company and will recommend how to get the best value from an OH service.  It may be that the service has stipulated in the SLA that anyone not accepted for a role at pre-placement or before dismissal (whether from capability or ill-health) will see an OHP or have a letter from the Specialist to protect against such findings in a Tribunal.  However, this will add cost and time to the contracted services perceived efficiency and costs.

Clients get frustrated at the wait for reports and costs (Specialist reports can cost tons) and tend to blame the OH service for lack of action.

4. Pension Schemes

Ill health retirement rules are generally set by pension Trustees. OH need to know these rules so that the necessary reports are available to grant or refuse access to a pension.

5. What to ask for in a report to GP/Specialist

When writing for a report from a GP (with consent) I tend to ask for a ‘copy’ of the person’s medical file which will include all copies of entries and Specialist reports too.  The OH professional would then go through the entries looking for evidence.  This is helpful when OH need to give an OH opinion on disciplinary matters linked to health.  Generally speaking its best not to ask an opinion as this may compromise the GP/patient relationship. Sometimes it confuses both the employer and the employee who are both torn between what an OH professional might recommend and what the GP has said, making it unpleasant and often causing more problems than it solves.

Specialists tend to produce a more balanced report than the GP report because the Specialists do not have the same close relationship with the patient. The GP may not have the benefit of statistical outcomes to inform their opinions – so specialist reports are more helpful in dismissal and ill-health retirement cases, but only if you ask the right questions.

5. The Cost of GP and Specialist reports

Most businesses offer a standard rate for a copy of the person’s GP file or report (say £100).  Most Doctors will accept a fair price and invoice without too much trouble.  If it is likely to cost more, ask the GP/Specialist to contact you to discuss. You will then have to make your decision on the proposed content of the report.  The manager usually pays for the report, so you will have to check to see how much they are willing to pay. Some specialists ask for hundreds of pounds!

6. Minimise delays in GP/Specialist reports returning

I ask the individual to keep chasing the Doctor if there is a delay in the report coming back.  This means the employee contacts the health professional if the report is late. Sometimes the GP/Specialist is waiting for the employee to go see the report (an option on the consent form).  I advise that it would be best to send the report in now and send a copy to their patient anyway.

If you would like a free template GP/Specialist report to adapt/use there is one available for subscribers to my website using this link

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