Occupational Health Support
Navigate fit notes, OH referrals, reasonable adjustments and return-to-work plans with expert HR guidance. We help you support employee health while protecting your business.
Why Occupational Health Guidance Matters
Occupational health is a specialist area that bridges the gap between an employee's medical condition and their ability to do their job. When an employee is on long-term sick leave, has a condition that affects their performance, or needs adjustments to their role, an occupational health referral can provide the objective, professional assessment that employers need to make fair decisions. Crucially, occupational health focuses on function, not diagnosis. An OH report will tell you what an employee can and cannot do in relation to their specific role, whether adjustments would help, and when a return to work is likely. This is the information you need to manage the situation fairly, and it is often the evidence you need to defend your decisions if a dispute arises later. Under the Equality Act 2010, employers have a duty to make reasonable adjustments for employees with a disability (defined in section 6 as a physical or mental impairment that has a substantial and long-term adverse effect on normal day-to-day activities). An occupational health assessment is one of the key tools for identifying what those adjustments should be.
Many small businesses are unsure about when to make an OH referral, how to write the referral questions, what to do with the report once they receive it, or how an OH assessment interacts with their legal obligations. Some employers make the mistake of relying solely on a GP's fit note, which often provides limited information about the employee's functional capacity in a specific role. Others delay the referral because they are worried about the cost or unsure whether the employee will agree to it. These delays can make the situation worse, both for the employee who is not getting the support they need and for the employer who is making decisions without adequate information. It is worth noting that an employee cannot be forced to attend an occupational health appointment, but an unreasonable refusal to cooperate may be relevant if the employer later needs to make decisions based on the information available.
At Rebox HR, we do not provide clinical occupational health services. We are HR consultants, not medical professionals. What we do is coordinate the occupational health process on your behalf, from identifying when a referral is appropriate through to acting on the recommendations in the report. We draft the referral letter with targeted questions relevant to the employee's role, liaise with the OH provider, help you interpret the report, advise on reasonable adjustments, and support you through the return-to-work process. We also help employers access the government's Access to Work scheme, which can fund workplace adjustments for employees with disabilities or health conditions. Whether you are managing a long-term absence, a complex disability situation, or simply want advice on how to handle a fit note, we provide the practical HR guidance you need.
What We Cover
Practical, expert support across every aspect of occupational health for your business.
Occupational Health Referrals
We help you identify when an OH referral is appropriate and draft the referral letter with specific, role-related questions that will get you the information you need. Generic referral questions produce generic answers. We tailor every referral to the employee's role, the issues you are managing, and the decisions you need to make. We also manage the logistics of the appointment and follow up with the OH provider if the report is delayed or unclear.
Interpreting OH Reports
An occupational health report is only useful if you understand what it means and what you need to do as a result. We review every report with you, explain the recommendations in practical terms, and advise on the next steps. If the report is vague or does not answer your questions, we go back to the OH provider for clarification. We make sure you have the clear, actionable information you need to manage the situation fairly and in line with your legal obligations.
Reasonable Adjustments Advice
Under section 20 of the Equality Act 2010, employers must make reasonable adjustments where a provision, criterion, or practice puts a disabled employee at a substantial disadvantage compared to a non-disabled person. We advise on what adjustments are reasonable in the context of your business, covering changes to duties, hours, equipment, the physical workplace, and management support. We also help you document the adjustments agreed and review them over time to make sure they are still working.
Return-to-Work Planning
Getting a return to work right is critical, both for the employee's wellbeing and for your business. We help you plan phased returns, agree on adjusted duties or hours, conduct return-to-work meetings, and put ongoing support in place. A well-managed return reduces the risk of the employee relapsing and going off sick again, and demonstrates to a tribunal that you acted as a reasonable employer. We provide templates and attend return-to-work meetings with you if needed.
Fit Note Guidance
Since 2022, fit notes (Statements of Fitness for Work) can be issued by GPs, nurses, occupational therapists, pharmacists, and physiotherapists. A fit note may say the employee is 'not fit for work' or 'may be fit for work' with certain adjustments. We help you understand what a fit note means in practice, what your obligations are, and when a fit note alone is not enough and an OH referral is needed. We also advise on the interaction between fit notes, SSP entitlement, and your absence management policy.
Access to Work Support
The Access to Work scheme is a government programme that provides grants to help disabled employees or those with health conditions stay in work. It can fund workplace adjustments, specialist equipment, support workers, and travel costs. Many small businesses are not aware of the scheme or how to apply. We help you identify whether an employee may be eligible, guide them through the application process, and make sure the adjustments funded by the scheme are implemented effectively in your workplace.
How We Help
A clear, structured approach from start to finish.
Consultation
You tell us about the situation, whether it is a long-term absence, a fitness concern, a request for adjustments, or a fit note you are unsure how to act on. We advise on the best approach and whether an occupational health referral is appropriate.
Referral and Assessment
If an OH referral is needed, we draft the referral letter, coordinate the appointment, and follow up with the provider. Once the report is received, we review it with you, explain the recommendations, and advise on the practical and legal implications for your business.
Action and Support
We help you implement the recommendations from the OH report, whether that means putting reasonable adjustments in place, planning a phased return to work, or managing a situation where the employee is unlikely to return. We support you through every step and make sure your decisions are fair, documented, and legally sound.
Frequently Asked Questions
When should I refer an employee to occupational health?
You should consider an OH referral when an employee has been absent for an extended period (typically four weeks or more), when their health is affecting their ability to perform their role, when you need to understand what reasonable adjustments might help, when you are managing a phased return to work, or when a GP's fit note does not give you enough information to manage the situation. An OH referral is also advisable before taking any formal action related to absence or capability, as it demonstrates that you have sought professional advice and acted reasonably. Under the Equality Act 2010, failing to obtain an OH assessment when managing a potentially disabled employee could undermine your defence if a discrimination claim is brought.
Can an employee refuse to attend an occupational health appointment?
Yes. An employee cannot be physically compelled to attend an OH appointment or to consent to the release of the OH report. However, you should explain clearly why the referral is being made, how the information will be used, and that it is in their interest to cooperate. If an employee unreasonably refuses, you may need to make decisions based on the information available to you, which could be less favourable to the employee than the information an OH report would have provided. You should document the refusal and the reasons given, and proceed fairly based on what you know. We advise on how to handle refusals and make sure your approach is reasonable and well documented.
What is the difference between a fit note and an occupational health report?
A fit note (Statement of Fitness for Work) is issued by a healthcare professional, usually a GP, and provides a general view of whether the employee is fit for work or may be fit with adjustments. It is based on the employee's self-reported symptoms and a clinical assessment, but the GP will not usually have detailed knowledge of the employee's specific role or workplace. An occupational health report is produced by a specialist OH practitioner who assesses the employee's functional capacity in relation to their specific job. It typically provides more detailed, role-specific recommendations about what the employee can and cannot do, what adjustments would help, and when they are likely to be able to return to full duties. Both documents serve different purposes, and we often recommend an OH referral when a fit note alone does not provide enough information.
What are reasonable adjustments under the Equality Act?
Under sections 20 and 21 of the Equality Act 2010, employers have a duty to make reasonable adjustments where a provision, criterion, or practice, a physical feature of the workplace, or the absence of an auxiliary aid puts a disabled employee at a substantial disadvantage compared to a non-disabled person. What is 'reasonable' depends on factors including the cost and practicality of the adjustment, the size and resources of the employer, and the likely effectiveness of the adjustment. Common examples include flexible working hours, modified duties, ergonomic equipment, additional breaks, working from home, and providing a support worker. The duty only applies where the employer knows, or could reasonably be expected to know, that the employee has a disability. An OH referral is one of the main ways employers establish whether the duty applies and what adjustments are appropriate.
How much does an occupational health referral cost?
The cost of an OH referral varies depending on the provider and the complexity of the assessment, but a standard management referral typically costs between £200 and £350 plus VAT. More complex assessments, such as those involving a psychiatric evaluation or a workplace assessment, may cost more. The cost is borne by the employer, not the employee. While this may feel significant for a small business, it is substantially less than the cost of getting a sickness or disability situation wrong. An OH report can prevent protracted absences, reduce the risk of discrimination claims, and give you the evidence you need to make fair decisions. We can recommend reputable OH providers and help you get the most value from the referral by asking the right questions.
What should I do if an employee is on long-term sick leave?
Long-term absence management requires a structured approach. You should maintain regular contact with the employee (without being intrusive), review their fit notes as they are received, and consider an occupational health referral to understand the likely duration of absence and any adjustments that might facilitate a return. You should also be aware of your obligations under the Equality Act 2010 if the employee's condition may amount to a disability. Statutory Sick Pay (SSP) is payable for up to 28 weeks, after which the employee may be able to claim benefits. If there is no realistic prospect of the employee returning to work, dismissal may be an option, but only after you have followed a fair process, obtained medical evidence, and genuinely explored alternatives. We support employers through every stage of long-term absence management and make sure decisions are fair and legally sound.
Do I need to get the employee's consent before making an OH referral?
You do not need the employee's consent to make a referral, but you do need their cooperation to attend the appointment, and the OH provider will need the employee's consent before releasing the report to you. Under the Access to Medical Reports Act 1988, if the OH practitioner contacts the employee's GP or specialist for further information, the employee has the right to see the report before it is sent to you and to request amendments. In practice, it is best to explain the referral process to the employee, discuss the questions you will be asking, and reassure them that the purpose is to support them. A transparent approach makes cooperation more likely and demonstrates good faith if the matter is ever scrutinised by a tribunal.
Can occupational health recommend dismissal?
No. An occupational health practitioner provides medical opinions and recommendations about an employee's functional capacity, likely prognosis, and potential adjustments. The decision about what action to take, including whether to dismiss, is always the employer's. An OH report might indicate that an employee is unlikely to return to work in the foreseeable future, or that no reasonable adjustments can be made to enable them to perform their role, but the employment decision remains yours. We help employers interpret OH recommendations and make fair, informed decisions that take into account the medical evidence, the needs of the business, and the legal framework, including the Equality Act 2010 and the Employment Rights Act 1996.
“Natalie and Faye have provided great support over the last few years during the good and the not so good moments. Offer a great balance of listening and sharing advice when it mattered. Their business deserves to grow and succeed!”
Related Services
Absence Management
Comprehensive support for managing short-term and long-term employee absence, including absence policies, trigger points, return-to-work processes, and SSP compliance.
Absence Management →Health & Safety
Health and safety support for employers, including risk assessments, DSE assessments, and compliance with the Health and Safety at Work Act 1974.
Health & Safety →HR Advice
Same-day HR advice from CIPD-qualified consultants. Whether you need guidance on a fit note, a sickness absence situation, or an employee's request for adjustments, we are here to help.
HR Advice →Need Help With Occupational Health?
Whether you need guidance on making an OH referral, help interpreting a report, or support managing a long-term absence, we are here to help. Book a free, no-obligation consultation and let us guide you through the process.
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