Occupational Health Referral: What Happens and How to Prepare

An occupational health referral means your employer has asked a specialist work and health service for independent advice about how your health is affecting your work, and what might help. You will usually have a conversation with an occupational health nurse or doctor, by phone, video or in person. With your consent, they then write a report for your employer. It covers whether you are fit for your job, what adjustments might help and roughly when things might change. Your employer reads that advice and decides what to do with it.

A referral is not a disciplinary step in itself, although it can sit alongside an absence or capability process. It is not a test you can fail either. Done well, it is one of the more useful things an employer can do for you. Done badly, it is a box ticked. How much you get out of it depends a fair bit on how you prepare, which is what most of this page is about.

What occupational health actually is

Occupational health is a branch of healthcare that looks at two things: how your health affects your ability to work, and how your work affects your health. Large employers sometimes have their own in-house team. Most smaller organisations buy the service in from an external provider.

The people you are likely to speak to are occupational health nurses and occupational health doctors (physicians), many with specialist qualifications in this area. Some services also include physiotherapists, psychologists or occupational therapists.

The important thing to understand is that occupational health advises. It does not usually treat you, take over from your GP, prescribe medication or sign you off. Your employer pays for the service, but the clinicians you see still have professional duties: to keep your medical information confidential and to give honest, independent advice. They are not there to argue your employer's case, and they are not your advocate either. Think of them as the impartial person in the middle who understands both health and work.

Why employers refer people

The common reasons are:

• You have been off sick for a long stretch and your employer wants advice on a return to work.
• You have had a number of shorter absences and they want to understand whether there is an underlying health issue.
• You are at work but struggling, and you or your manager have raised it.
• You have told your employer about a health condition or disability and they want advice on adjustments.
• There is a question of whether work itself is causing or worsening a health problem, such as stress, back pain or a repetitive strain.
• Your job involves health surveillance, for example because of noise, vibration or certain substances, which some employers have to carry out by law.
• Your employer is considering redeployment or, at the far end, ill health retirement.

Good practice is for your manager or HR to talk to you before making the referral, explain why, and tell you what questions they are asking. If that has not happened, ask for a copy of the referral form. It is reasonable to want to know what you are being assessed for, and it makes the appointment far more useful because you can prepare for the actual questions.

Consent: what you agree to and what gets shared

Agreeing to the appointment

You cannot be physically made to attend an occupational health appointment or to answer questions. But your employer is entitled to make decisions using whatever information they have, and if you refuse, they may make those decisions without medical advice. That rarely works in your favour. If you have concerns, raise them with HR or your union rep first rather than simply not turning up. Your contract or sickness absence policy may also say something about attending, so it is worth checking.

Agreeing to the report

Consent to the appointment and consent to the report going to your employer are usually two separate things. Many providers will ask you at the end of the appointment whether you are happy for the report to be released, and whether you want to see it first. If they do not ask, ask them. It is common for people to be offered the chance to read the report before it is sent, and you can request this.

What the report usually includes and leaves out

A good occupational health report focuses on the functional effects of your health, not your medical details. Your employer is likely to read something like "has a condition that affects concentration and stamina, likely to improve over the next few months with treatment", rather than a diagnosis and a list of medicines. Clinicians generally only include specific medical information if it is relevant and you have agreed to it.

If there is something you do not want your employer to know, say so during the appointment. The clinician can tell you whether it can be left out without making the advice meaningless.

If they want to contact your GP or specialist

Sometimes occupational health asks for a report from your GP or hospital consultant. Because that doctor has been responsible for your care, the Access to Medical Reports Act 1988 applies. In general terms, you must be told and give your written consent, you can ask to see the report before it is sent, and you can ask for corrections or attach your own comments if the doctor disagrees. The details are on legislation.gov.uk, and your GP surgery can explain how they handle these requests.

What happens at the appointment

Appointments are increasingly by phone or video, with face-to-face visits used when someone needs to be seen, for example for a physical check or health surveillance. The length varies, so ask the provider when you book.

Expect questions about:

• Your health condition, how it started and how it has changed.
• Treatment you are having or waiting for, in general terms.
• Your symptoms day to day: pain, energy, sleep, concentration, mood.
• What you can and cannot manage at home, which gives a picture of your function.
• Your job: the actual tasks, hours, travel, physical demands and pressures.
• What is happening at work, including relationships and workload, if relevant.
• What you think would help you stay at work or come back.

If you are seen in person there may be some simple physical checks. Otherwise it is a conversation. The clinician is trying to answer the questions your employer asked, so if your answers drift a long way from your work, they may bring you back to it. That is not rudeness.

How to prepare

1. Get the referral questions. Ask HR or your manager what they have asked occupational health to advise on.
2. Write a short timeline. When it started, when you went off sick or began struggling, appointments so far, what is planned next.
3. List your medicines and treatments. Names and what they are for is enough. Note any side effects that affect work, such as drowsiness.
4. Gather letters. Clinic letters, discharge summaries and recent fit notes, especially any that suggest amended duties.
5. Break your job down. Write the main tasks and mark which are fine, which are hard and which you cannot do right now. Be specific: "driving more than an hour", "standing at the till all shift", "back-to-back video calls".
6. Note your good and bad days. A week or two of brief notes is far more convincing than "it varies".
7. Think about solutions. Changed hours, a phased return, home working, different tasks, equipment, more breaks. Our guide to reasonable adjustments at work has examples.
8. Decide what you want kept private. Then you can say so clearly on the day.

On the day

For a phone or video call, find somewhere quiet where you will not be overheard. Have your notes in front of you. Be honest. People often underplay things because they want to seem keen, or overplay them because they are worried about being pushed back too soon. Neither helps. Describe your worst days and your best days and let the clinician weigh it up. If you want someone with you for support, ask the provider beforehand whether that is possible.

The report and what happens next

The report usually answers your employer's questions: whether you are fit for your role now, whether you might be with changes, how long recovery is likely to take, what adjustments are recommended, and when a review would be sensible. It may give an opinion on whether the disability provisions of the Equality Act 2010 are likely to apply. That is ultimately a legal question, not a medical one, but the opinion helps.

Then comes the part people often misunderstand. The recommendations are advice. Your employer decides. Occupational health cannot make your employer do anything. Your employer should consider the advice properly, usually in a meeting with you, and agree what will happen. If you have a disability under the Equality Act, your employer has a legal duty to make reasonable adjustments, and the report is often the starting point for working out what those are. GOV.UK and ACAS both explain this in plain terms. If an adjustment costs money, Access to Work may help pay for it.

If you disagree with the report, tell occupational health quickly, particularly about factual errors. You can ask them to correct facts and you can give your own written comments to HR. If things become difficult, talk to your union rep if you have one, or the ACAS helpline for free, impartial advice.

Your right to see the report and your records

Beyond being offered the report before it is sent, you have a general right under data protection law to ask for a copy of the personal information an organisation holds about you, which includes occupational health records and the report your employer received. This is called a subject access request. The Information Commissioner's Office website explains how to make one and the timescales organisations must meet. Usually it is simpler just to ask the occupational health provider or HR first.

Occupational health and occupational therapy: not the same thing

The names cause endless confusion. Occupational health is a service, usually led by nurses and doctors, that advises employers about fitness for work. Occupational therapy is a profession. Occupational therapists are registered with the HCPC and work in hospitals, the community, schools and privately, helping people manage everyday activities, including work, when health or disability gets in the way.

Some occupational health teams include occupational therapists, but most occupational health appointments are not with one. The difference matters because an occupational health report often says what should happen ("consider a phased return and adjustments to workstation") without spelling out exactly how. That is where an occupational therapist can add detail.

Where an occupational therapist fits

A private occupational therapist can carry out a detailed workplace and ergonomic assessment, either at your workplace, at your home office, or both. Rather than a conversation about your health, it looks at the work itself: each task, step by step, and how your condition affects it. From that they can recommend specific equipment, changes to how tasks are done, a graded return-to-work plan, and ways to manage fatigue, pain or concentration through the working day.

This tends to be most useful when:

• Your condition is complex or fluctuating, such as after a stroke or brain injury, with chronic pain, long Covid, MS or a hand injury.
• You are neurodivergent and generic adjustments have not worked.
• The occupational health report recommends adjustments but nobody knows what they should look like in practice.
• You work from home and your set-up is part of the problem.
• Your employer, an insurer or a solicitor needs a detailed functional report.

Either you or your employer can commission one. It works best when it builds on the occupational health advice rather than competing with it.

An occupational therapist is not the right person for everything. Your GP handles diagnosis, treatment and medication, and is usually who you see for a fit note, although hospital doctors and some other registered professionals, including occupational therapists, can also issue them. A physiotherapist leads on rehabilitation of muscles and joints. For mental health, your GP is the first stop, and in England you can also refer yourself to NHS Talking Therapies. Our guide to getting mental health support explains the routes. For disputes with your employer, it is ACAS, a union or an employment solicitor. If your health is getting worse while you wait for any of this, see your GP or call NHS 111. In an emergency, call 999.

Frequently asked questions

Can my employer force me to see occupational health?

No one can make you attend or answer questions. But your employer can make decisions about your job based on the information they have, and refusing usually leaves them deciding without medical advice. If you are worried, speak to HR or a union rep about your concerns before declining.

Will occupational health tell my employer my diagnosis?

Not usually without your agreement. Reports generally describe how your health affects your work rather than naming conditions or listing medication. If you would prefer something kept private, tell the clinician during the appointment.

Can I see the occupational health report before my employer does?

You can ask to, and many providers offer this as standard. You can then point out factual errors before it is sent. You can also ask for a copy of your records later through a subject access request.

Is occupational health on my side or my employer's?

Neither, in theory. Your employer pays, but the nurses and doctors have professional duties of confidentiality and independence. Their job is to give fair advice that helps you work safely and helps your employer support you.

Does a referral mean I am going to lose my job?

No. Most referrals are about getting people back to work or keeping them there with the right support. A referral can be part of a longer absence or capability process, so if you are worried, ask HR directly where it fits and get advice from a union rep or ACAS.

What if I disagree with the report?

Contact the occupational health provider promptly to correct facts, and put your own comments in writing to HR. Bring any evidence from your GP or specialist to your meeting with your manager. Remember the report is advice and the final decision sits with your employer, so the conversation that follows matters.

Next steps

If your report recommends adjustments and you need someone to work out the detail, see our work and ergonomic assessment page or functional assessments and reports, check current guide prices, and choose your area below.