Helping SMEs understand occupational health

Dr Kabir Abraham Varghese , occupational health physician at London North West University Healthcare NHS Trust

Dr Varghese is part of a dynamic team providing occupational health services to a large NHS trust in London. He is also a GP working for a busy practice in Hertfordshire. 

Small and medium-sized enterprises (SMEs) are the biggest employers in the UK. At the start of 2021, SMEs accounted for 61% of the employment and around half of turnover in the UK private sector (reported in small business statistics from the Federation of Small Businesses). 

Sickness absence costs the UK economy £100 billion annually (as reported by Public Health England), which places a disproportionately higher burden on SMEs, clearly impacting their productivity, efficiency and therefore profits. 

We will cover important tips about referring employees to occupational health to help:

  • optimise staff management
  • manage their condition
  • improve sickness absence

Have a sickness absence policy

Have a clear sickness absence policy. Acas has advice if you need help writing a policy. It should state:

  • the expectations for both the employee and the employer
  • how to report absences and who to contact
  • when a fit note is required
  • information about keeping in touch when an employee is absent
  • how much sick leave an employee can have before further attention from a manager is needed

What information occupational health need and what they can do

Occupational health deal with medical problems and assess if an individual can do their job. For example, does the medical problem affect them walking, standing, sitting or processing information and how does this impact on their job?

It is important to understand what information you require from the occupational health professional. For example, is the referral about long-term absence, short-term absence, or to discuss adjustments? Occupational health only have the information provided in the referral, so it is helpful to include:

  • the job description
  • how long the employee has worked for the employer
  • relevant fit notes
  • how much time the employee has taken off so far with this condition or a related condition
  • any relevant medical conditions
  • any specific questions about the condition at work

It is useful to explain what employee support you have already provided. For example, if an employee had injured their back and you provided lumbar support, this should be mentioned in the referral. 

Similarly, it could be whether they have been signposted to an employee assistance programme (EAP) so that relevant occupational health advice can be given. 

Occupational health need to know if there are performance issues like:

  • poor work output, for example the back pain means that the employee cannot sit for long periods and so the amount of desk-based work produced suffers
  • serious mistakes, for example the back pain meant that they dropped and damaged expensive equipment
  • time keeping, for example the back pain means that they find it difficult to drive to work and are often late

One of the biggest causes of sickness absence is an industrial dispute. The employee may be awaiting the outcome of disciplinary proceedings or there may be workplace bullying. 

Even though these issues are not occupational health related, they often appear via an occupational health referral. Management should be aware that occupational health only focus on the work-related health issues arising and how best these can be managed. We do not adjudicate on industrial disputes.

Reasonable adjustments

Is the employee:

  • unfit for work
  • fit for work
  • fit for work with reasonable adjustments?

If they are unfit, when are they likely to return, if at all? Reasonable adjustments are changes that organisations must make in their approach or provision to ensure that services are accessible to disabled people as well as everybody else. 

The Equality Act 2010 defines an individual as disabled 'if they have a physical or mental impairment that has a substantial and long-term negative effect on their ability to do their normal daily activities'. Occupational health professionals can give their opinion if an individual is classed as disabled under the Act. 

Find out more about reasonable adjustments

Communication is key

Always speak to the employee about the referral and ensure that you get their consent for it. 

Management should know that an employee has a right to see the report before it's released and they can refuse consent for the report to be released. If this happens the manager must try and do the best they can without medical guidance. 

It is vital that there is good communication between the employee and employer during the process. When both parties talk openly and frequently it can help to build up trust and get a better outcome. Keep in touch with employees who are off work sick – they will still need management support. 

Stick to the policy. It is there so that everyone is aware of the obligations of both parties. 

Sometimes an occupational health referral does not help. If this happens, you should consider external support from organisations like Acas and the Society of Occupational Medicine

Read Acas advice on using occupational health at work