When should you refer an employee to Occupational Health?

Don’t wait for absence to become a bigger problem.

Put simply, you should make an Occupational Health referral as soon as an issue is affecting an employee's ability to do their job, especially when you’re unsure how to support them safely and without legal risk.

You do not need to wait for long-term absence. In most cases, it’s far better to act early – businesses that wait too long often end up with a situation that is harder, slower, and more expensive to resolve.

Why your timing matters: the cost of waiting.

Delaying a referral is one of the most common mistakes you can make, and it usually costs more than the referral itself.

According to the CIPD (2023), sickness absence costs UK employers an average of £772 per employee per year. For small businesses, a single long-term absence case can exceed that figure quickly and that is before factoring in management time, reduced output, and the effect on the rest of the team.

The Office for National Statistics (ONS, 2023) reported 185.6 million working days lost to sickness or injury across the UK in a year. A significant share of those cases become long-term because early support did not happen.

The pattern is predictable:

1. An employee shows early signs - declining performance, repeated short absences, a change in behaviour
2. The manager handles it informally and hopes it will resolve itself
3. Absence increases, or the situation becomes more complex
4. By the time Occupational Health is involved, the employee may already be disengaged, off long-term, or at risk of not returning at all

A referral at step one almost always produces a better resolution than a referral at step four.

What an Occupational Health referral gives you

Before looking at when to refer, it helps to be clear on what you get.

An Occupational Health assessment carried out by a qualified OH nurse or physician gives you:

• A clinical opinion on how a health condition is affecting the employee's ability to work
• Clear, medically informed recommendations on what adjustments to consider
• Guidance on what is practical in your specific workplace
• A written report you can use to make defensible management decisions
• Support in meeting your obligations under the Equality Act 2010

This isn’t about taking decisions out of your hands but giving you the evidence you need to make those decisions properly, alongside a record that shows you acted reasonably.

UKIM Occupational Health provides reports written in plain terms, focused on what the employee can and cannot do, and what you as the employer need to consider next. The advice is clinically led, but practical and actionable.

 

Seven signs you should refer an employee

1. Absence has lasted more than seven days, or keeps repeating

If an employee has been off for more than a week, or you’re seeing the same employee absent repeatedly (every few weeks, always on a Monday, always with a vague reason) a referral is appropriate.

Why it’s important to act:

• Repeated short-term absence frequently signals an underlying issue the employee may not have disclosed
• Early clinical input can prevent a short-term pattern becoming long-term
• A referral moves you from reactive to proactive, which is better for the employee and easier for you to defend

Don’t wait for the situation to become "long-term." By that point you’ve already lost the best opportunity for intervention.

2. You have a Fit Note but are not sure what to do with it

Fit Notes are issued by GPs after appointments that typically last eight to ten minutes. They give a general opinion on fitness for work. They do not tell you what adjustments are practical for the employee’s specific role, or your specific premises / working pattern.

If the Fit Note says, "may be fit for work," "phased return recommended," or "avoid heavy duties," and you do not know how to make those adjustments within the employee's actual job, then you should make a referral.

A UKIM Occupational Health assessment will tell you what those recommendations mean in practice, what adjustments are realistic, and - critically - whether the guidance in the Fit Note reflects what the employee can do in their role. (See also: Occupational Health vs a GP Fit Note, explained below.)

3. Performance is being affected by a possible health issue

This is where many managers hesitate, because the situation feels like a performance issue than a health one.

If an employee is missing deadlines, making unusual errors, or showing a noticeable change in concentration or energy - and you think health issues may be a factor - refer before you start any formal performance process.

Referring protects both parties:

• You avoid running a process that turns out to have been an inappropriate response to a health condition
• The employee gets clinical support before the issue escalates into something harder to manage

The Health and Safety Executive (HSE, 2023) reported that stress, depression, or anxiety account for 49% of all work-related ill health cases in the UK. In many cases the issues with work-related performance are a signpost for cases of this type.

4. There are signs of a mental health issue

Mental health is the leading cause of long-term absence in the UK.

Refer if you notice withdrawal, a marked change in behaviour, increased absence linked to stress, or if the employee has disclosed anxiety, depression, or burnout (even informally). You don’t need a formal diagnosis to make a referral.

Waiting for a diagnosis before acting is one of the most common delays, and a UKIM referral gives you clinical input at the point where it can still make a real difference.

5. You are thinking about disciplinary or capability action

If there is any possibility that health is a contributing factor to the issue you are considering addressing formally, pause and refer first.

This step ensures:

• You have medical evidence before making a decision that could be challenged
• You are not inadvertently treating a health condition as a conduct or capability matter
• You have demonstrated reasonable behaviour if the matter ever reaches a tribunal

Skipping an Occupational Health referral before capability or disciplinary action is a common cause of costly disputes – and it’s one of the most straightforward to avoid.

6. You need to establish whether adjustments are required

Under the Equality Act 2010, in cases where an employee has a condition that meets the definition of a disability, you have a legal duty to make reasonable adjustments. The test of what is "reasonable" depends on factors including the size of your business, the cost of the adjustment, and how much it would help the employee.

If you’re unsure whether an employee's condition qualifies – or what adjustments would be appropriate and how long they should remain in place - an Occupational Health assessment gives you a clinical opinion on each of those questions, and a documented basis for the decision you reach.

7. The situation is becoming unclear or difficult to manage

Sometimes there’s no single trigger other than a growing sense that the situation is beyond what you can manage informally – a good indicator that a referral is needed.

If you’re spending significant management time on an employee's situation without a clear path forward, UKIM can give you the structure to move things forward, without unnecessarily escalating a situation.

 

Should you refer now? A quick checklist…

If you answer yes to any of the following, a referral is an appropriate next step:

• Has the employee been off work for more than seven days?
• Are absences becoming frequent or forming a pattern?
• Are you unsure how to support a return to work?
• Is performance being affected by a possible health issue?
• Has the employee mentioned stress, anxiety, burnout, or another condition?
• Are you considering formal capability or disciplinary action?
• Do you need clarity on whether adjustments are needed under the Equality Act?

If you hesitate on any of these questions, that suggests you need external support with your next steps.

What happens if you delay

Three things tend to follow a delayed referral:

Absence becomes harder to resolve. The longer someone is off work, the less likely they are to return quickly. Clinical feedback after two or three weeks leads to much better outcomes than the same feedback after twelve weeks.

Your costs rise. It’s not just salary during absence – you must consider reduced capacity, covering the role, management time, and the effect on the broader team. These costs rarely appear on a balance sheet, but they accumulate.

Your legal risk increases. Without medical input, decisions about absence, adjustments, or capability become harder to defend. That is where disputes arise, and where ACAS early conciliation and employment tribunal claims begin.

In short: early referrals turn difficult situations into manageable ones, while late referrals tend to do the opposite.

When you can manage internally instead

Not every situation requires an immediate referral. Managing internally is usually appropriate when:

• The absence is clearly short-term and single-episode - a cold, a minor injury
• There is no pattern and no underlying concern
• The employee returns to work fully and quickly, with no change in performance or behaviour

If any of those change (if the absence extends, recurs within a few weeks, or if performance doesn’t recover on return) reassess your referral decision quickly.

Occupational Health vs a GP Fit Note: what is the difference?

This is a question we hear regularly, and it’s important you understand the practical differences.

A GP Fit Note is issued following a short appointment, typically eight to ten minutes. That provides a broad view on whether the employee is fit or unfit for work. It doesn’t consider the demands of the employee's role, the layout of your premises, or the adjustments that would be practical for your business.

An Occupational Health assessment is different in scope and purpose. UKIM's clinicians assess how the health condition affects the employee's ability to carry out their duties. The report they produce covers fitness for work, recommended adjustments, whether a phased return is appropriate, and - where relevant - whether the employee's condition is likely to be covered by the disability provisions of the Equality Act 2010.

You are not required to follow the Fit Note if you have Occupational Health advice that reaches a different conclusion. A number of employment tribunal decisions have upheld employers who acted on clinical OH advice rather than the Fit Note, in cases where that advice was properly sought and documented. ACAS guidance supports this approach.

 

How a referral with UKIM works

Our process is straightforward, and most employers find it less daunting than expected.

Step 1: Identify the concern

You recognise one of the signs above, or the situation has become unclear enough that clinical input would help. You don’t need certainty – that’s what the assessment is for.

Step 2: Discuss the referral with the employee

Before submitting a referral, speak to the employee. Explain the purpose - that it’s about getting the right support in place, not about discipline. ACAS guidance is clear that occupational health works best when the process is open and transparent. Most employees respond better to referral when it is framed as support rather than scrutiny.

Best practice is to share a copy of the referral form with the employee before it is submitted. This gives them the opportunity to see what information has been included, and to raise any factual inaccuracies.

Step 3: Submit a management referral

UKIM uses an online referral system. Your referral should include the employee's details and job role, the reasons for the referral, a brief summary of the absence or performance situation, the specific questions you need answered, and details of any support already provided.

Step 4: The employee attends the assessment

The employee will be seen by an UKIM Occupational Health nurse or physician - by telephone, video, or face-to-face depending on the clinical requirements. The assessment is confidential. The clinician cannot share the report without the employee's consent.

Step 5: You receive the report

UKIM provides reports within a short turnaround time following the assessment. The report will cover:

• The employee's current fitness for work
• Whether the condition is likely to be covered by the Equality Act 2010
• Recommended adjustments, with a view on what is clinically justified
• Whether a phased return is appropriate, and at what pace
• Likely absence duration, where it can be estimated

The report is yours to act on. UKIM's clinicians advise but the employment decision is ultimately yours.

What if the employee refuses consent?

An employee cannot be forced to attend an Occupational Health assessment. Referrals are voluntary.

If an employee refuses to consent to the assessment or refuses to allow our report to be shared with you, the clinician cannot release it. In that situation, you will not receive formal clinical advice on fitness for work or adjustments.

However, you can still make management decisions. You are entitled to proceed based on the information you already have - absence records, performance data, your own observations, and any discussions you have had with the employee. Document carefully that consent was declined and that you made your decision on the best available information.

ACAS guidance acknowledges this position: the absence of a report does not remove your ability to act, but it does make proceeding less certain. The more detailed your prior documentation, the more defensible your decisions will be.

If an employee refuses and the situation is complex, particularly where capability action or a potential Equality Act consideration is involved, then taking early legal advice alongside the Occupational Health route is sensible.

Frequently asked questions

When is the earliest you can refer an employee to Occupational Health?

You can refer as soon as a health issue is affecting work or absence. There is no minimum absence period. Early referrals - before a situation becomes long-term - consistently produce better outcomes for both the employee and the business.

Does the employee have to consent?

Yes. The employee must consent to the assessment and to the report being shared with you. If they decline, you can still manage on the information available, but you will do so without clinical input (see the consent section above for more on how to handle a refusal).

Is Occupational Health only for long-term sickness absence?

No. It is often most effective in short-term or early-stage situations, before patterns become entrenched. Reactive use – for instance, waiting until someone has been off for weeks - is the most common approach, but not the most effective one.

What is the difference between a GP and Occupational Health?

A GP treats illness. Occupational Health assesses how that illness affects an employee's ability to carry out their specific role. The detail you receive ia different: a Fit Note gives a general view, while an OH report gives employer-focused, role-specific recommendations (see the full comparison section above).

How long does a referral take?

UKIM aims to provide reports promptly following assessment. Straightforward cases are typically turned around quickly; complex cases may take longer. Contact us directly for current turnaround times and to discuss the urgency of your situation.

Can I make decisions based on the OH report rather than the GP Fit Note?

Yes. You are not bound by the Fit Note if you have clinical OH advice. A number of employment tribunal decisions have upheld employers who acted on OH advice in preference to the Fit Note, provided the referral was properly conducted and the decision was documented.

Refer an employee today

If you recognise any of the signs in this guide, your next step is straightforward.

UKIM Occupational Health works with employers across the UK to provide clear, practical assessments - written by qualified clinicians, focused on what you can actually do next, and turned around without unnecessary delay. Contact us today using our short form below.

If you have a question before making a referral, you can speak the UKIM team directly. Initial conversations are at no charge, and there is no obligation. Call us today on 0333 049 2872.