REFERRALS TO OCCUPATIONAL HEALTH

MARCH 2008

Introduction

This briefing explains the background to referrals to Occupational Health Services (OHS), offers advice about meeting with a medical adviser and returning to work after a period of sickness absence.

The Burgundy Book Sick Pay Scheme

Under paragraph eight of the Sick Pay Scheme, conditions attaching to the payment of sick pay are set out and these include:

“In the case of prolonged or frequent absence, the teacher undertakes any examination that the employer may require by an approved medical practitioner, subject to the provisions of the Access to Medical Reports 1988 where applicable.”

Sickness Absence Monitoring

The Government has, since 1988, pursued various initiatives to reduce absence rates in the public sector. DfEE Circular 4/99 ‘Physical and Mental Fitness to Teach’, issued in May 1999, included advice on the importance of absence monitoring procedures.

All local authorities are now expected to have in place policies relating to the management of sickness absence which, in the view of the Government, are intended to ensure that:

  • lost working time is minimised;
  • return to work of teachers following illness or injury can be facilitated and supported in a way that will optimise the return to full teaching duties;
  • following illness or injury, the teacher is fit to resume teaching duties and that any reasonable adjustments are considered to facilitate the return to work of teachers with a disability;
  • work-related causes of illness or injury can be identified, investigated and addressed in order that other employees are not similarly affected.

The Occupational Health Service

“Occupational health services are multi-disciplinary and may involve, for example, occupational hygienists, ergonomists and safety officers. For teachers and teacher employers, first contact with an occupational health service is likely to be via an occupational physician or nurse. The occupational physician generally carries the professional responsibility for occupational health advice where the employee has a health-related problem which could affect their fitness to teach.”

“Occupational health guidance for the training and employment of teachers”. 2000

It is important that occupational health services used by employers should focus on providing ongoing support for employees to remove any barriers in the workplace. Any medical requirements or assessments should be very closely linked to the actual tasks to be performed and should be subject to reasonable adjustments. Rejecting someone on the basis of a medical diagnosis, where this is irrelevant to the job, is direct discrimination under the DDA 1995.

The NUT recommends that employers use only occupational health services that have an enabling, DDA aware approach to providing these services, focussing on reasonable adjustments rather than screening out of employees with impairments. Employees should ensure that they understand their responsibilities under the DDA 1995. Local Authorities should support head teachers and governing bodies in becoming more DDA aware.

Referral to the Medical Adviser

If a teacher is to be referred to the OHS medical adviser, it is the manager’s responsibility to ensure that the individual being referred is made fully aware of the reasons for referral. Members should request a written explanation for the reasons for referral from their manager.

The teacher will be asked to provide written consent to allow the medical adviser access to medical information from the teacher’s GP and/or consultants.

Some occupational health services make provision for “self referrals” from employees. This can be a useful route for members wishing to access certain occupational health services such as counselling or where an employer is refusing to make reasonable adjustments under the DDA. Members should take advice from the Regional Office/NUT Cymru before making a self-referral to their occupational health service.

Access to Medical Records 1988

Under the Access to Medical Reports Act 1988, individuals have the right to see medical reports written about them for employment or insurance purposes. They can exercise this right either before or after the report is sent, and can add their own comments to the report if they disagree with any of its contents, or even withdraw their consent to the release of the information.

Any organisation seeking a medical report on an individual for employment or insurance purposes (hereafter referred to as ‘the applicant’) must secure the consent of that person (‘the patient’) prior to approaching a medical practitioner. The applicant must also inform the patient of their rights under the Act, namely:

  • to withhold permission, i.e. to refuse to consent to the release of the information;
  • to see the completed report before or after it is sent to the applicant; and
  • if seeing the report before it is sent, to withhold permission for its release or to request its amendment.

The patient may ask to view the report at any time within six months of consenting to the release of information.

If the patient requests access to the report in advance of its release to the applicant, the doctor must retain the report for a period of 21 days in order for this to take place. Once the patient has seen the report and agreed to its release, however, the doctor may forward it to the applicant even if the 21 day period has not yet elapsed.

This 21 day rule applies whether the patient asks to see the report at the time of giving consent to the report being written, or after it has been completed but before it is sent to the applicant.

If the patient withholds their consent for the release of the report, the doctor must not send it, regardless of the 21 day rule. In other words, the doctor must not dispatch the report until and unless they have received the patient’s consent.

Should the patient disagree with anything in the report, the doctor may amend the report if they consider that the patient’s objections are justified.

The doctor does not have to amend the report, but in such cases must allow the patient to append a statement to the report regarding the disputed information.

Any request on the part of the patient to change or add to the report must be made in writing.

In keeping with the provisions of the Data Protection Act, a doctor has the right to withhold from the patient:

  • any information likely to cause harm to the mental or physical health of the patient (this is unlikely in the context of employment or insurance reports); or
  • any information which might reveal data about another person, or the identity of a person other than a health professional acting in their professional capacity.

In such cases, the doctor must inform the patient of any restrictions, but must still make the remainder of the report available.

Meeting the Medical Adviser

When meeting the medical adviser, a teacher may be accompanied by a friend or representative. A teacher has the right to have their GP present if they wish.

After the referral meeting, the medical adviser will consider any written information provided by the teacher’s GP and/or consultant and compile a report. The report will be sent to the teacher’s employer. In community schools, the report will usually be sent to the personnel department and copied to the headteacher.

“Occupational physicians and nurses are bound by professional requirements to maintain confidentiality in relation to medical information. Maintenance of this is also crucial in retaining the trust and confidence of the employees concerned. This does not, however, impact upon the quality of advice that can be offered since it is the implications of any diagnosis in relation to fitness to teach, not the diagnosis itself, which the manager needs to know”.

“Fitness to Teach OHS Guidance”

The report will normally incorporate the following:

  • when a teacher is likely to be fit to return to work or the minimum period for which they will continue to remain absent;
  • when they are able to return to work, whether they will be fit for their full teaching duties, or whether there will be some limitations, what those limitations will be and whether they will be temporary or permanent;
  • whether they are covered by the Disability Discrimination Act (see below);
  • whether their employer can do anything to facilitate recovery and return to work;
  • whether redeployment or other adjustments should be considered;
  • whether the cause of absence is work-related or not;
  • requirement for further review.

Where relevant, the meeting should be viewed as an opportunity for them to indicate to their employer’s medical adviser any steps that their employer should be taking to assist them at this time to ensure that when they do return to work it will be on a permanent basis.

The guidance from the Medical Adviser’s report will be used by their employer to determine how their eventual return to work will be managed. They should prepare for their meeting. They should discuss the situation with their doctor, NUT representative, division secretary or regional office in England or NUT Cyrmu in Wales. They should make notes of the points they wish to raise and be included in the Medical Adviser’s report. They should take their notes to the meeting.

Examples of adjustments requested by members in this situation include:

  • a phased return to work;
  • moving to part-time work;
  • special requirements such as a chair;
  • making adjustments to premises;
  • changing room allocation(s);
  • a more reasonable timetable/workload;
  • an extension of paid sick leave;
  • redeployment.

They should ensure that they receive a copy of the Medical Adviser’s report. If there are any errors in the report they should write to the Medical Adviser, explaining any inaccuracies and request a copy of the revised report.

If the Medical Adviser suggests a course of action that they are unhappy with, for example a return to work earlier than they believe is appropriate, they should discuss this with their GP and ask their GP to write to the Medical Adviser on their behalf, recommending a more suitable arrangement.

The Disability Discrimination Act 1995

The Disability Discrimination Act (DDA) places a legal duty upon employers not to discriminate against disabled employees under the terms of the Act and to make ‘reasonable adjustments’ appropriate to the individual and the barriers faced by that employee.

The DDA defines a disabled person as someone who has “a physical or mental impairment which has a substantial and long-term adverse effect on his (sic) ability to carry out normal day-to-day activities”.

An impairment has a long-term effect if it has lasted or is expected to last for at least 12 months. The definition covers physical, sensory or mental impairments which can include stress and depression or anxiety; progressive conditions such as cancer, muscular dystrophy, multiple sclerosis, and HIV infection; severe disfigurements and people who have had a disability in the past. Employees with cancer, HIV and MS are automatically covered by the DDA from the point of diagnosis.

DfES Circular 20/99 sets out guidance and advice on what the DDA means for schools and local authorities.

It lists some examples of adjustments which governing bodies and/or LAs might have to make to facilitate the employment or continued employment of disabled teachers.

The list is replicated below:

  • altering premises, e.g. widening a doorway, providing a ramp, stair-climbing chairs or non-slip flooring, moving classroom or corridor furniture, altering lighting, or providing parking spaces for disabled drivers;
  • allocating some duties to another employee, e.g. asking a non-disabled teacher to assemble a slide projector and screen for a disabled teacher, providing ancillary support in the classroom, arranging supervision duty rosters to take account of mobility, e.g., library supervision may be more appropriate than playground supervision for a disabled teacher;
  • transferring the person to fill an existing vacancy, e.g. if a teacher becomes disabled and there is no reasonable adjustment which can enable them to continue in their post they might be considered for another suitable post. In the case of local authority maintained schools, the local authority may be able to recommend the teacher for a suitable vacancy at another school;
  • altering working hours, e.g. allowing an employee who becomes disabled to work part-time or to job share or making adjustments to the timetable;
  • changing the person’s place of work, e.g. ensuring that a teacher with mobility difficulties which prevents them from using the stairs can hold all of their lessons in classrooms on the ground floor;
  • allowing absences during working hours for rehabilitation, assessment or treatment, e.g. allowing an employee who becomes disabled time off during work to receive physiotherapy or other treatment;
  • supplying additional training, e.g. training in the use of particular pieces of equipment unique to the disabled person or re-training a teacher in a new subject area in order for them to continue teaching;
  • acquiring or making changes to equipment, e.g. providing an induction loop in the school hall and other assembly areas, providing magnifying facilities, a pager that vibrates, a visible fire alarm system, or an adapted telephone; or
  • providing a reader or signer, e.g. reading information to a visually impaired person at particular times during the working day.

Access to Work

Financial assistance for schools/governing bodies making reasonable adjustments may be available from the Government’s Access to Work Programme. This is run by the DWP via the Job Centre network and can provide assistance towards additional costs resulting from disability. Some examples include:

  • additional fares to work;
  • special equipment;
  • adaptations to equipment and buildings.

Information about Access to Work can be obtained from the Disability Service Teams at local Job Centres.

Further Information

  • Fitness to Teach: Occupational Health Guidance for the Training and Employment of Teachers.
  • Obtaining Occupational Health Advice on Fitness to Teach – A Guide for Teacher Employers and Managers.

(These documents can be viewed at

  • DfES Circular 4/99 – Physical and Mental Fitness to Teach and of entrants to Initial Teacher Training.
  • DfES Circular 20/99 – what the Disability Discrimination Act means for schools and local authorities.

(These documents may be accessed via

  • Implementing the Disability Discrimination Act in schools and early years settings (DfES/DRC), available from

NUT advice on the teachers’ Sick Pay Scheme, Absence Monitoring Procedures and the DDA can be found on the website at

Health and Safety Department

March 2008