Management referrals & HR: How best to enlist the help of an Occupational Health provider
Many of the calls I receive come from managers looking for information on how to refer an employee for an occupational health assessment. What looks daunting from the outside should be a straightforward process, even if referrals come with complex histories. Below I go through what a management referral process looks like, offering advice and tips for managers.
Reasons for referral
Managers come to occupational health seeking assistance for different reasons. This can be because they have an employee:
- with several short-term absences;
- injured on the job;
- going into a long-term absence;
- requiring accommodations or adjustments;
- suffering musculoskeletal or mental health difficulties;
- returning to work after absence;
- asking for occupational health assistance;
- etc
Whatever the reason, making a referral to occupational health is usually the next best step.
After an employee illness or absence, managers might feel unsure about what to do to ensure their employee is safe in their job role. They have questions about how to meet regulatory and legal requirements and are seeking impartial advice on what’s best to do for their business, as well as for the employee.
Once managers get to the point of seeking the assistance of an occupational health provider, they are usually facing complex cases carrying some history and uncertainty. When you’ve got a complex problem, it may seem the solution would be equally as difficult. That’s not necessarily true.
Informed consent & confidentiality
When you seek the advice of an occupational health clinician, you’re required to submit a management referral. Before you make the referral, however, you first need the employee’s permission.
Best practice is to have an employee’s signed consent. In order to get the advice you need, you may have to divulge information the employee may not want other parties to know, even if those other parties are bound to medical confidentiality. You should have their consent to do so.
The employee should be told about all aspects of the referral, including information you as a manager may think is confidential. The reason for full disclosure is that an occupational health referral is considered the employee’s medical information; the employee has a right to see it at any time.
Sharing sensitive information with occupational health can be important for the manager making a referral. As mentioned earlier, cases have complex histories before a referral to occupational health is even considered. You may feel you need to share information with the occupational health provider that you would not necessarily want the employee to know, such as management notes and personal thoughts about the employee’s reasons for absence. Managers need to be aware that the employee has a right to view this information and can request copies of communications regarding their referral.
The occupational health clinician must show the referral to the employee should they ask and may share it with them at the beginning of an appointment to ensure the employee understands their reasons for being referred and what advice their employer requires. They don’t do this to be difficult. The law requires them to do so. It would be counterproductive if at this point the employee saw something they weren’t aware of when they gave their initial consent.
There have been cases where the employee said they didn’t know what questions were in the referral, nor the information that would be shared. Some referrals have contained privy management discussions and internal reports – the manager didn’t realise the employee has a right to see this if it’s in the referral, which caused difficulty and distrust.
An experienced occupational health provider should let you know if they receive a referral with sensitive information, ensuring you are aware of the employees right to view it. Best practice is to ensure you are not sharing information you would rather keep confidential.
Trusting occupational health
An employee may be afraid of involving occupational health. In most cases, employees express some nervousness about the prospect. They may feel their job is on the line or that they are in trouble.
It’s always best to have a one to one with the employee prior to referring. Let them know occupational health advice is better for them than doing nothing at all in order to have appropriate medically supported advice before making decisions.
You may want to mention that the occupational health clinician would recommend accommodations and adjustments to help the employee to be well enough to return to work, as well as equipment recommendations, phased return to work plans, and other helpful advice.
One of the main objectives of occupational health is to have an employee safely fulfilling their job role in the healthiest possible way whilst ensuring the employer is aware of their obligations. This helps the employer avoid lost productivity and protect their employee, and helps the employee find confidence through work, get back on full wages, and feel supported. It’s a win-win situation.
Occupational health clinicians provide impartial advice. It’s important for employees to know this.
Having a one to one with the employee about the referral and how it can help is very reassuring. Once you have spoken with the employee, you would then make an occupational health referral.
How to refer
Whether a provider uses a portal or has a secure form, referrals should be easy to make and confidential. Ensure that the method of referral is GDPR compliant, encrypted, and uses a secure website.
Complete each section of the referral ensuring you include any questions you want answered, and attach documents that are relevant including:
- Job description
- Absence records
- Risk assessments
- Previous occupational health reports
- Medical records the employee has consented to share
Basic questions that are automatically answered in each occupational health report are:
- Fitness for work
- Timescale for a return to work
- Adjustments required under the Disability Discrimination Act 1995 & Equality Act 2010
- Timescale for a return to full normal job
- Recommendations regarding alternative employment
- Recommendations regarding Ill Health Retirement
You should be able to submit the referral and receive or download an encrypted copy after submission. The employee can also receive a copy of the referral, although most occupational health providers will leave that to your discretion. The employee will be able to see it at the appointment, in any case.
Triage
The occupational health provider should triage the referral to decide the most appropriate clinician to give you the management advice you need.
The appointment can be with an occupational health nurse advisor or physician. Maybe you need the advice of a specialist physiotherapist with an occupational health designation and an ergonomics degree. Sometimes the employee may be best seen in their working environment to assess ability to perform job functions and look for any gaps requiring special equipment or adjustments. Experienced triage staff understand the outcomes managers are seeking, what the law requires, and can advise on the appointment type that would give the best advice and recommendations.
Costs
Some occupational health providers require a contract or other type of joining fee. Collingwood Health takes ad hoc referrals without a fee or contract. At Collingwood Health there is no cost to using the process up to the point of submitting the referral. Once a referral is triaged, a cost for the appointment is sent back to the manager: costs quoted should include administrative and report writing time, as well as extras such as ordering a GP report, if indicated.
Costs for a management referral vary depending on the appointment type and location. You can expect a nurse advisor appointment to range between £200 and £295, and a physician appointment to run between £300 and £650; it depends on the provider.
Costs explained
A busy city occupational health clinic typically runs at a higher cost. This is because it is easier to access, has a higher rent value, and attracts a higher level of clinician. If you are using a smaller village location, the cost may be less. Ensure you are getting the advice and service you require, regardless of cost.
A provider with many years of experience behind their brand would also be pricing higher due to having higher level occupational health physicians and nurse advisors on staff with a large administrative team supporting them to meet KPI for occupational health report turn arounds, including GDPR compliance and medical records storage. The occupational health provider may also be contracting the occupational health appointment out to associate clinics, which increases their overheads.
If you are receiving a lower cost for an occupational health appointment, questions you may want to ask of the provider should focus on the referral being triaged to the best appointment type for you to receive the proper advice you need, clinical experience, KPIs, and security of data. Remember, you do get what you pay for. Cheapest is not always best, especially if you’re serious about getting quality occupational health advice.
Appointments
Once you’ve accepted the cost, an occupational health provider should either book an appointment directly with the employee and advise you, or book an appointment through yourself, with you advising the employee of the details.
Some occupational health services will book an appointment immediately with you and leave it up to you to work out the details with the employee. This might look efficient but can be less than helpful: can’t get in touch with the employee? You’d best remember to cancel the appointment before the cancellation period comes into force or be left paying the cost.
Cancellation terms
Most occupational health provider cancellation terms run between 5 and 3 business days, with a fee attached for cancellation within those days. Forget to let them know and you will have to cover the cost of the appointment. This is a good reason to find a provider that can arrange appointments directly with the employee and advise you if the employee wants to cancel within the cancellation term. An experienced provider has case managers that can persuade an employee to attend an appointment where they are not too poorly. In some cases, the employee is just frightened to attend.
Case managers
Experienced occupational health case managers will be able to track down and arrange appointments with employees that are nervous about engaging with occupational health or have other reasons for not wanting to make an appointment. These case managers can try several times to get in touch with the employee at different times of the day and week, taking that burden off your workday. The cost you are paying should include this service.
Case Managers should be able to discuss the employee’s rights, concerns, and answer their questions regarding occupational health appointments, and have the processes in place to let you know as soon as an appointment is booked.
The report
Once the appointment takes place, you should expect a timely occupational health report with answers to your referral questions and any advice you need to know.
Sometimes an occupational health report will give answers you weren’t expecting or didn’t ask for; this is because the clinician is required to give you the advice. This could be due to the Disability Act, the Health & Safety Executive, or another regulatory body or law.
Report KPI
You should receive an occupational health report within 5 business days, sometimes sooner. If it takes longer, you may want to call the provider as soon as possible. A tip: call instead of sending an email. Calls need to be answered immediately. An email may take some time to receive a reply.
Delays
There could be a good reason the report has not been sent over to you.
The employee may not have consented for the report to be released. Even though employers are paying for the assessment, legally employees are allowed to choose to see the report before it is released to their employers. Some employees feel confident enough to allow the report to be released directly to their employer; if not, the release of the report is delayed.
Employees have a right to make adjustments to factual details if they see an error. Sometimes a report might be delayed because the employee has requested adjustments that require clinical oversite. A good occupational health provider will keep you updated.
Amendments
Businesses should always receive an impartial occupational health report. Employees cannot make changes that are biased, and they cannot ask a report to be changed if their request conflicts with medical advice. The same goes for employers.
If the employee has asked for a conflicting amendment, the occupational health clinician must review the request. If the physician is reviewing a report amendment, it may delay the release of a report. It is important to remember there should be no cost to employers for this extra physician review time.
Keeping you in the loop
A good occupational health service should be following up with the employee and let you know there is a delay as soon as they’ve been made aware.
You should expect to receive a call or note advising the report is going through amendments. It’s important to get your occupational health report in a timely manner. You need advice quickly in order to make management decisions surrounding the staff member’s employment. Some decisions are time sensitive: If your employee is back to work in two weeks, you should receive your occupational health report with the phased return to work plan before that happens. A good occupational health provider will ensure you get the report in a timely manner.
Advice in the report
The occupational health report ought to provide you with succinct and timely answers to your questions, as well as advice to ensure the employee is safe and healthy in their role.
The report should give you some understanding of the employee’s condition and if they are taking appropriate measures to manage their conditions, such as taking the right medication (without listing it) or attending the right treatment programmes.
Perhaps the employee requires further time to recuperate but will return eventually. The occupational health report should advise this, as well as recommend a phased return to work programme, if appropriate. You may see advice about further assessments, like a workplace assessment, or if the employee needs counselling or physiotherapy. Perhaps the clinician will recommend a special type of mouse for the employee, a padded standing mat, or a new ergonomic chair. The employee might require time off to go to medical appointments. Maybe it is time to consider ill health retirement.
The type of recommendations and advice are as numerous as the number of medical conditions and job roles. What’s important is that the occupational health clinician provides you with this advice. If the report doesn’t provide it, you should be calling your provider for clarification.
After the report
After sending out a report, an occupational health provider should keep your data safe, protect the employee’s medical information following all rules and regulations, and ensure they have followed up on any recommendations in the report.
Reviews
If the employee requires a follow-up or review, the occupational health provider should be communicating this to you and helping you to arrange it. If further medical evidence is required, the cost to order this should be communicated to you prior to ordering it so that you are aware of and approve costs. Similarly, if the employee was seen by an OH nurse advisor and now needs an OH physician, this escalation should be communicated to you with costs so that you are able to understand the reasons and give approval.
Typically, a new referral isn’t required for reviews or escalations unless a significant amount of time has elapsed since their initial consultation. This is usually more than 6 months. In any case, the provider should be advising you of next steps; if they are to follow-up with you about a review, a proactive provider should be able to track when it’s due and get in touch with you for authorisation and request updated information.
Summary
An occupational health provider should be managing your referral process from start to finish, offering you helpful advice and easy ways to interact with their service. You should be looking for experienced established providers with clinicians holding a long history of occupational health knowledge. Seek out those with good KPIs that are backed up by efficient professional teams following a process that turns around the advice you need quickly and professionally. Ask about response times and communication. Ensure you are hearing from the supplier when you need to and are getting the value you deserve.
The Collingwood Health team is happy to discuss a case in confidence before a referral is made. We can advise you on how to complete a referral and give you an indication of cost before you get started. Please give us a call.
Nichole Humphrey is the Sales & Marketing Manager at Collingwood Health. She has managed occupational health service delivery for Collingwood Health and works to ensure their processes and procedures meet customer expectation.