"Management referrals" to the Occupational Physician
Introduction
University managers sometimes need medical input to a decision about a member of staff. Common examples are: fitness for work in a hazardous environment, fitness to return to work after illness or injury, consideration of ill-health retirement, advice on sickness absence including planning the return to work, meeting the requirements of the Disability Discrimination Act (1995), whether an illness may be caused or made worse by work, or whether a decline in work performance or an episode of misconduct could be caused, in whole or in part, by ill-health.
Management referrals are often complex and this guide provides advice on making an effective referral. It does not cover pre-employment health assessments, ill-health retirement, self-referrals, statutory health surveillance, or any other work carried out by the UOHS. Please contact us (282676) if you have queries about this guide or any other matters.
A management referral is not the same as retaining a doctor on the management “side” in opposition to another doctor on the member of staff’s “side”. The occupational physician aims to be unbiased, obtaining factual medical information for you and providing a report containing the necessary facts, interpretation, specialist professional opinion, and recommendations to support you in taking management decisions. The report will, in normal circumstances, be shared with the member of staff.
Monitoring the health of your staff
You should be aware of ill-health in your staff, balancing reasonable interest from the employer with the risk of appearing intrusive about sensitive personal information. For example, all departments should have a system for monitoring sickness absence (see Personnel Handbook) and, bearing in mind the risk of appearing intrusive, you should keep in touch with staff who are at home with an illness or injury.
Welfare
If your only concern is the welfare of the individual and you do not foresee the necessity for any management decisions, you should advise the member of staff to make arrangements to see their general practitioner (for general health problems) or to contact the UOHS (if the problem is made worse by work, or interferes with work). The UOHS will provide a health assessment and appropriate advice to the member of staff, informing you if there is a need for you to modify a work task or work environment.
Obtaining medical advice
If, however, you believe that, in addition to welfare issues, the University needs to take some form of management decision, and medical information will influence it, then you should consult the UOHS. Please do this at an early stage. In very straightforward cases you may find that an informal discussion answers your questions. But usually it is necessary to carry out a medical assessment and provide a formal report. Bear in mind that we may request additional medical information which may not be available for some weeks or months. Where a health problem is part of a complex mixture of performance or conduct concerns, grievances and counter-grievances, you must also consult your sector personnel advisor.
Formal referral
A"management referral" is a referral of an individual to the Occupational Physician by a university manager with the aim of receiving a medical report which will influence a management decision. The referral should be made by the head of department, or by a senior administrator, or sector personnel advisor, acting on the head of department's behalf.
Information for the member of staff
You should discuss your concerns with the individual, explaining why you are making the referral, the information you require and, in broad terms, the likely management action which may result. It is good practice to copy your referral letter to the member of staff, together with any enclosures, such as sickness absence records. Any lack of clarity causes confusion, and even suspicion. It may also delay your medical report because, if the occupational physician cannot satisfy himself or herself that the member of staff understands the purpose for which the report may be used, s/he is ethically obliged to terminate the consultation.
Referral letter and headings
Please use the Occupational Health Service Management Referral Form to make your referral
If the individual has been seen by us before, please mention this in the letter so that, where practicable, we can make the appointment with the same occupational physician. Use separate letters when referring more than one individual. Please provide the following information in your management referrals:
- Name of individual
- Individual's contact address and telephone number (which may be at home)
- Job description
- Sickness absence record, including reasons for absence, over the last 12 months or a longer period if relevant
- Reason for referral from your perspective (please be as concrete as you can and it is helpful if you can relate your concerns to specific tasks)
- Information you would like to have covered in the medical report, considering what you want the referral to achieve
- In broad, general terms, the management decisions you are considering (eg monitoring performance). If there are relevant matters which you feel are particularly complex, or confidential to the department at this stage, please discuss them informally with the senior occupational health nurse, or the Occupational Physician.
- Confirmation that you have discussed the reasons for the referral with the member of staff
- Any other information you think is relevant, including any communications from other doctors
Consent to referral
Even though asking for a medical report is a reasonable management decision a member of staff may well refuse a management referral. In such cases, you should consult your sector personnel advisor and inform the member of staff that refusal may force you to take management decisions without the benefit of a medical report. The occupational physician is obliged to satisfy himself or herself that the member of staff consents to the assessment and understands the purpose of the medical report before carrying out an interview, a medical examination, tests, or obtaining additional information from another doctor.
Consultation
The OHS will make an appointment, which will be as soon as practicable. The occupational physician will make an assessment of the individual and obtain informed consent for any additional information required from another doctor.
Report
Time permitting, we will make attempts to contact you by telephone after the consultation to answer your immediate queries. You will receive a written report as soon as all information is received, and we will be happy to send interim reports in a protracted case. This report will be different from a doctor-to-doctor letter in that it will not usually contain medical details except with the individual’s permission and when their inclusion will clearly help you. It aims to give you unbiased professional advice, providing the necessary facts, interpretation, specialist opinion, and recommendations to support you in taking management decisions. The medical report is, however, only one piece of information for you to consider in reaching a decision. If you feel a report has not answered a question, please contact the doctor who wrote the report to ask for further details. We would appreciate brief feedback on the outcome of individual cases, especially complex cases, to help us in continually improving our ability to advise you.
Copies of reports and other correspondence and action
We will normally copy reports to the member of staff. We will telephone or write to the individual’s general practitioner when this is necessary for clinical reasons. We will be happy to provide medical input to any other individual or agency, as the situation requires.
Case-conferences
With complex questions, it is often helpful to discuss solutions with the occupational physician (or occupational health nurse) and others, such as a personnel advisor, disability advisor, safety officer or others. We will suggest and arrange a case-conference if it seems to us a desirable way forward and will be happy to participate in case-conferences at your request.
Assessments in the workplace
The report may include a recommendation for a workplace assessment. This is an assessment of the member of staff in the workplace in order to give advice specifically tailored to both the medical condition and the individual’s job. We will make every reasonable effort to arrange the visit at your convenience and will be happy to provide medical input to any other individual or agency, as the situation requires.
Follow-up
We will arrange follow-up if there are good reasons, for example to see if an individual’s sickness absence has fallen following surgery or completion of a course of treatment. Otherwise, we will not normally follow cases over a period of time, though we will be happy to see the member of staff again if new problems arise.
If you receive medical reports from other sources
You may on occasion receive a report or letter directly from the member of staff’s GP or other doctor. You must send any such reports to the Occupational Physician and ask the doctor to communicate through the Occupational Physician. This will allow the occupational physician and the patient’s medical advisor to communicate medically confidential information on a doctor-to-doctor basis. It is important to appreciate that a GP, or hospital consultant, however experienced, is unlikely to have knowledge of the patient’s workplace or to be recognised by the GMC (and courts or tribunals) as competent in occupational medicine. He or she has no obligation to provide unbiased advice to the University but has a clear obligation to protect the patient’s interests (except in highly unusual scenarios where life or death matters of public interest take precedence).
Medically-qualified managers
Medically-qualified managers naturally form medical opinions about the health of their staff but must make referrals to the Occupational Physician in the same way as non-medical managers. If you, in effect, take on the clinical role and responsibilities of the Occupational Physician, you could be regarded by the GMC or your professional liability insurers as exceeding the boundaries of your clinical competence. Even if the individual’s medical condition falls within your own specialty, you are advised to resist the temptation to give medical advice and to avoid potential conflicts of interest between your managerial and medical roles. Pragmatically, in your managerial role, you are unlikely to be privy to all pertinent medical information.
Access to Medical Reports Act 1988
An employee’s GP or consultant can disclose medical information to the Occupational Physician but only with the informed consent of the member of staff, who has legal rights to access the report and make comments. Consent must be obtained by the Occupational Physician, who is also ethically responsible for explaining the potential consequences of the disclosure.
Confidentiality
Medical confidentiality issues have been covered in other places in this guide. In your department, correspondence containing personal medical information must be stored securely and the individual’s privacy should be respected in conversation. We recommend that emails are not used for personal medical information on named individuals.
The OHS takes every reasonable precaution to protect sensitive information about third parties which may be disclosed in medical consultations.
Access to one’s own health records
Individuals have the right to read their own occupational health records on request. Others, such as the individual’s solicitor or the University solicitor, can have access with informed consent. These requests are processed by the Occupational Physician, who is obliged to satisfy himself or herself that the individual understands the purpose of the disclosure and has given informed consent. A court has the power to override the individual’s wishes and to order the Occupational Physician to disclose the records. Your letters form part of the occupational health record and, although there is some debate about whether letters from managers have the same status as clinical records, it would be wise to assume that any referral letters could be read by the individual or by others.
K M Venables
August 2001
Circ: All HODs, Departmental Administrators, Departmental Safety Officers, Equal Opportunities Officer, Disability Advisers, all Personnel staff.