Guide to occupational health reports
This guide is intended to support those who have just received an occupational health report, having already commissioned opinions and advice from an occupational health clinician.
Please view our separate pages on occupational health assessments if you are seeking to arrange an occupational health report.
The guide explains:
- The information contained in an occupational health report
- Common language patterns and phrases
- How you should store an occupational health report
- How to use an occupational health report
- When to use an occupational health report
- Seeking clarification
What does an occupational health report contain?
An occupational health report is the output arising from an occupational health assessment (sometimes also called a “management referral”).
The reports should always contain some key content:
- Identifying the employee who is the subject of the report
- Identifying the employer and contact who has commissioned the report
- The name, qualifications and GMC/NMC registration number of the assessing clinician
- Confirming the date of the assessment and the medium (in-person/remote/phone)
- Clarifying why the assessment was requested and the consent of the employee to participate
- Background information and what was covered in the consultation
- A summary of the current/medical situation
- Opinions and advice to answer the questions raised in the referral to occupational health
Every doctor in the UK is bound by strict standards set by the GMC when disclosing information for employment, insurance or other similar purposes.
The reporting requirements that apply to primary care (the ‘normal treating clinician’) and occupational health (acting in an independent advisory capacity) have some common features (the duty of candour, informed consent etc), although are also different in some important ways.
The Health and Work Handbook explains some important differences, although the main point is that occupational health reporting falls outside the Access to Medical Reports Act 1988 (AMRA) framework (because occupational clinicians are not medically responsible for the care being provided to the employee). AMRA provides long periods for patients to review material before it is released and individual’s also have the right to insist that information is withheld.
Whilst employees have a right to review an occupational health report, occupational clinicians are only obliged to amend any factually incorrect information. This means that the opinions and advice contained in the report do not have to be changed, should the employee ask for changes to be made.
The employee does always have the right to withdraw consent for a report to be released. Whilst this may be frustrating for the employer, it does then mean that the employer may make management decisions without the benefit of medical advice. It is very difficult for an employer to be sued for failing to support an employee, if the employee will not allow them access to the medical information needed to support them (see Elmbridge Housing Trust v O’Donoghue for details).
The Faculty of Occupational Medicine and the Society of Occupational Medicine both suggest that occupational health reports should be factual, concise and not share any information which is not explicitly relevant to answering the questions raised in the referral.
An occupational health report may state that an employee is fit, unfit or that restrictions or adjustments are required, but the employer generally should not know the clinical details driving the advice. The medical information behind some advice may occasionally be shared, although only with the explicit written consent of the employee.
Most assessments and reports follow a “bio-psycho-social” model, which assesses the physical and medical situation, the psychological situation and any relevant social elements (like family or work-related issues).
Common language and phrases
Many occupational clinicians use similar language in their reports, which helps to provide a consistent standard of support for employers and employees.
Some of the phrases Occupational Health Assessment Ltd commonly use are:
- “Prior sight” – the employee has asked to see a copy of the report, before being released to the employer
- “the employee perceives that” – this is not to say it what the employee perceives is factually correct, it is referencing what the employee perceives (this may then be a good prompt to consider investigating their concerns)
- “the employee alleges that”- this is not agreeing with the employee, it is just reflecting what they told the clinician
- “is likely to be covered by the Equality Act 2010” – means you should probably consider them as covered by the provision of the Act, as the clinician believes they are likely to be covered (ultimately a legal decision, rather than a medical decision)
- “you should consider” – you may wish to document your decision-making process and your objective reasons for making decisions, whilst considering whether you can follow the advice or not
How you should store an occupational health report
The Office of the Information Commissioner has provided detailed guidance for employers about how to manage employee health data. Our article “how to manage employee health data” explains the key steps and your obligations in plain English.
An occupational health report should only be shared with those who require access, in order to support or manage the individual. HR professionals may wish to consider only sharing the relevant sections of a report (e.g. suggested adjustments) with the line manager, rather than the entire report, although this is a decision for each business to make.
Employee health data, including sickness absence records and occupational health reports, should be held in a secure way, with access controls. They should never be shared widely within a team or business.
How to use an occupational health report
It is important to note that the opinions and advice contained in an occupational health report are just that – opinions and advice.
The business must choose what to do with the advice the report contains, which usually means use it as a basis for making reasonable decisions.
No occupational health clinician will ever say “and now you should dismiss” or “you must let them work part-time”. Rather, a report may say “they are unlikely to be fit to work in the next three months” or “the business could consider an alternative part-time role”. Occupational health only ever advise and inform – it is always up to the business to make management decisions.
It is very common for occupational clinicians to suggest alternative roles for a business to consider within a report. This is because
Occupational Health Physicians have a duty to suggest alternative possible roles for employees.
What is ‘reasonable’ (which also applies to ‘reasonable adjustments’) is only ever a legal decision, rather than a medical one.
However, following the advice of an occupational health clinician is intended to help support the employee, which also helps to reduce employment risks. Most occupational health reports are a good basis for making defensible management decisions (subject to the relevant facts of each case).
When to use an occupational health report
It is usually good practice to act upon medical advice as soon as it is received. Occupational health reports are best acted upon sooner, rather than later.
A judgement in 2021 from an Employment Appeals Tribunal highlighted that medical reports, if used as a basis for a capability dismissal, must be current. Current was indicated by the judgement to be within three months – and certainly no more than six months old. This is because someone’s health status may change a lot over a three-to-six month period.
That means if you choose to take the capability pathway, based upon medical advice obtained in January, subsequently taking a dismissal decision based on the advice in July or August, is likely to be unfair.
Some businesses choose to document their steps when considering an occupational health report – to record that they considered the advice and the objective reasons for, or against, following the advice the report contains. The aim is to help demonstrate compliance with the Equality Act 2010, which stipulates that employers must consider making adjustments to support a disability.
If you are unsure what the advice in an occupational health report means, most occupational health providers will be pleased to provide clarification.
Most requests for clarification are resolved very quickly and easily, although requests usually need to be made in writing, so that accurate records of any conversations may be retained.
The clinician can only comment on the information already contained in the report – they are unable to share “new” information, or answer new questions, based on what’s just been learned in the report. This is because the duty of confidentiality applies; the employee having only consented to sharing the information contained in the report.
If new information needs to be shared, it may be possible to create a report addendum, although the employee’s explicit informed consent will be required in order for new information to be shared.