Occupational health for PCN leaders: when to refer, what to ask, and how to read the report

At THC, we provide resources for primary care leaders. In this blog, we share what came out of a recent webinar on occupational health: when to refer, what to ask, and how to read the report. The webinar was supported by Joanne Harding, a HR specialist with over 22 years providing the full HR service to practices and PCNs across the country and Dr Shoby Sathananthan, a GP and occupational health practitioner.

We covered a lot of ground. Here is what stood out.

What occupational health actually is

Occupational health assesses whether an employee is able to do their role and whether any health condition is affecting their ability to work.

It covers fitness to do the role, often screened before someone starts, and support for someone already in post who is struggling or has been off long-term sick.

If occupational health confirms someone is fully capable of their role, you know the issue is not a health one.

If occupational health says they are fully capable to do their role, then we know it is a performance issue, and we can move to that policy as opposed to sickness.

What triggers a referral

The main triggers are sickness absence, particularly long-term sickness, a chronic illness the employer did not previously know about, and recovery after a procedure or operation, where someone needs guidance on returning safely. A new diagnosis is also common.

Stress, anxiety and neurodiversity also account for around 90% of occupational health referrals in primary care.

Start with the pre-placement assessment

If you take one thing from this blog, make it this. Both Jo and Shoby called the pre-placement assessment the single most useful step you can take.

It works as a conditional offer: you make the offer subject to references, a DBS check and occupational health clearance, with a form the candidate sends straight to occupational health.

They screen it and tell you whether the person is fit, fit with conditions, or not fit, usually including immunisation history. Many employers wait for that form before taking anyone on.

The value is knowing about a condition up front, so you can plan rather than react.

It is also a safeguard, because the form makes clear that withholding information can lead to the offer being withdrawn, which the panel said has helped when an issue surfaced later.

The cost is roughly £45-£60 per form, with a short telephone call sometimes added for a fuller report when there is high sickness or a particular condition.

The occupational health referral, and why consent slows it down

This is the route for someone already in post. You agree the referral with your HR adviser, complete the form with the specific questions you want answered, and occupational health then meets the employee and writes a report. You act on the advice, weighing up what you can realistically accommodate.

The assessment is quick, and the report can be ready within about a week. The delay is consent. The employee has to agree before you can see it.

They have up to 21 days in which to consent. If they do not reply within 21 days, we do send the report anyway.

They can ask for minor wording changes, but not for anything that alters the content or the clinician's opinion.

The report is advice, not an instruction

One of the most important points of the day: the recommendations are not legally binding. They are advice-based and tailored to the person and their condition. Some you will be able to act on, others may not be practical.

It is really a document where you and your employer can sit down and discuss ways forward.

Working through a report, Jo checks whether the person falls under the Equality Act 2010, whether they could do the role fully again, and whether a phased return or amended duties would work. If they never will, the options are redeployment or, as a last resort, dismissal on the grounds of incapacity.

Every option is looked at first. Sometimes, having heard an independent view, the employee decides for themselves whether to engage or to resign.

Capability or incapacity?

These two words tell you which policy to follow.

Capability, or performance management. If occupational health says the person is capable despite their condition, and they still do not do the job, this is a performance issue, handled under the capability or performance management policy.

Incapacity, under the sickness policy. If the person genuinely can no longer do the job and there is no suitable redeployment, this can lead to dismissal on the grounds of incapacity.

A clear example came up on the call. A driver who can no longer drive because of a DVLA restriction. You look first for redeployment. If there is nothing else, it becomes an incapacity matter under the sickness policy, because they can no longer do the job they were employed to do.

When you cannot accommodate an adjustment

This is the question PCN leaders most want answered. What do you do when you simply do not have the space, the room, or the cover to make an adjustment work?

Shoby described the report as a negotiating tool, not a list of orders.

There is a confidentiality angle too. When one person has adjustments, others notice and may ask why someone is being treated differently.

Managing that fairly is part of the job, and the answer is to be fair and consistent.

Stress, anxiety and neurodivergence

Stress, anxiety and neurodivergence now make up the large majority of referrals, and the right adjustment depends entirely on the role and the trigger.

Sometimes the cause is not work at all. If someone’s anxiety comes from something at home, they will often say they can still do their job. Where the trigger is work, the solutions can still be simple. A couple of hours doing quiet admin, a more back-office role, working in a quieter room, or a colleague who can step in on a difficult case.

For neurodivergence, a phone call before someone starts helps you understand what they can and cannot do. The difficulties raised were familiar ones. Being overwhelmed in a busy environment, long stretches on the phone, dealing with people shouting, and not feeling supported by colleagues or a line manager.

Some people find it hard to read from a screen but manage well with printed material and a little more time. Migraines came up as an emerging issue in admin and reception, where rotating tasks, dimming bright lighting and anti-glare screens can all help.

In Shoby’s own practice, with 35 staff, has funded a staff wellbeing package for about 15 years. Free eye checks, physiotherapy and mental health counselling is available for employees after six months of service. Jo noted these schemes are usually called Employee Assistance Programmes.

When you think someone is not being straight with you

This came up again and again in the chat. The occupational health clinician has never met the person before, so your referral form is what protects you. Keep the questions specific and answerable.

If you keep the form very specific to what questions you want answered, you will get a much better result. If you just say, how can we help this person, it goes off on a tangent.

Ask when they are likely to return, whether they need a phased return, and whether they can physically do the job. If someone tells occupational health they can do the job and then says at work that they cannot, you have firmer ground to manage it through performance.

If you have real doubts, you can ask for a GP report or a consultant report, and hospital and consultant letters are often already available.

Quick answers to the questions that came up

Can we contact someone who is long-term sick? Yes, unless the fit note specifically says no contact, in which case respect it. Otherwise, reaching out early to understand the problem is encouraged.

Is two weeks’ sick pay a year reasonable? Jo described two weeks at full pay and two weeks at half pay in a rolling year as reasonable. Some employers offer statutory sick pay only, some offer far more. This was context, not a recommendation.

Hep B vaccination, occupational health or pharmacy? It does not matter where, as long as it is done. Let people choose.

Someone is off sick from one job but working another. If it is the same kind of work, that is an investigation under the disciplinary policy and could amount to fraud. If the roles are genuinely different, it may be legitimate.

Is the process different for a GP or a receptionist? It is exactly the same, whatever the role.

What about PCN staff working across practices? Again, this would follow the same process. Jo speaks to the host practice that holds the contract to understand where the issues sit, and someone from the PCN may need to speak to the practice involved.

Starting the conversation

How you open matters. Lead with concern, not confrontation.

I have noticed you appear to be struggling with X and Y, or you do not seem as engaged as normal. Is anything wrong? Has anything happened? Do not do it in a confrontational or aggressive way.

You are just asking out of concern.

The wider lesson was to get in early. Most cases that break down do so because small things were left for months. The relationship frays, assumptions build, and by the time a referral happens, the two sides are already at odds. Most people want to work, and we need our teams, so usually both sides want the same outcome.

The policies you need in place

Jo’s closing advice was to have the right policies in place so nothing comes as a surprise and you can show you acted fairly.

People know they can be supported; they know what policy to look at, they know what you are following. So it is not a surprise when you say, we need to meet.

The policies named were a management of stress policy, a sickness policy, a capability or performance management policy, an appraisal policy, and a drug and alcohol policy.

Make sure staff know what occupational health is and what it is for, and that they can be referred to any Employee Assistance Programme or mental health first aid support you offer.

Do not forget the manager

Being the person who delivers difficult news is stressful too, and it is easily overlooked.

Jo’s approach is to walk the manager through the whole journey, from the first absence to the meetings themselves, helping them prepare what they want to say so they can follow it rather than read from a script.

Sometimes she says things to the employee on their behalf. And a manager can always take time before making a decision rather than deciding on the day.

What this means in practice

✅  Use a pre-placement assessment for new starters as a conditional offer.

✅  Keep referral forms specific, with clear, answerable questions.

✅  Treat the report as advice, not a binding instruction.

✅  Be clear whether you are dealing with capability or incapacity, because it sets the policy.

✅  Check whether the Equality Act 2010 applies.

✅  Contact staff on long-term sick unless the fit note says no contact.

✅  Allow up to 21 days for consent, after which the report is released anyway.

✅  Apply your policies consistently.

✅  Get in early, before small problems become entrenched.

✅  Support the manager, not only the employee.

We hope this helps, and if you need more support, please contact joanne@workforcewindow.co.uk, who will be able to guide you further.

About us

THC Primary Care is an award-winning healthcare consultancy specialising in Primary Care Network management and the creator of The Business of Healthcare. With over 20 years in the industry, we have supported more than 300 PCNs through interim management, training and consultancy.

Our expertise spans project management and business development across both primary and public sectors. Our work has been published in the London Journal of Primary Care, and we have authored over 250 blog posts sharing insights on primary care networks.

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