Management referral assessment
An impartial occupational health appointment, arranged by your employer with your consent, to advise both you and the employer on your health in relation to work.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- An impartial occupational health appointment that advises both you and your employer on health and work.
- It needs your consent, and you can usually see the report before it goes to your employer.
- Clinical details stay confidential; the report covers fitness, timescales and adjustments, not your diagnoses, unless you agree.
- It is not the employer's doctor judging you — it supports a fair, safe plan and reasonable adjustments.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Gives your employer impartial, expert advice instead of guessing about your health.
When you need diagnosis or treatment, which is for your GP or specialist, not occupational health.
You discuss your health and work, give consent, and explore adjustments. Many assessments are mostly a conversation.
A clear, impartial report that answers the referral and protects confidentiality.
You discuss your health and work, give consent, and explore adjustments. Many assessments are mostly a...
You can usually see it, correct factual errors, add comments, or withdraw consent for its release.
With your consent the report goes to your employer, who uses it to plan adjustments, a return to work or further...
A review may be arranged to check how adjustments are working or how your health is progressing.
What is a management referral assessment?
A management referral is when your employer asks occupational health for advice about your health in relation to your work — often because of sickness absence, a health condition affecting your job, or to plan adjustments or a return to work. You attend an appointment with an occupational health clinician, who then writes a report.
Occupational health is impartial. The clinician advises both you and the employer and is not 'the employer's doctor'. Their job is to give honest, balanced advice about your fitness for work and any adjustments, not to take sides.
Your clinical details stay confidential. The report normally contains advice on your fitness for work, likely timescales and recommended adjustments — not your diagnoses or the details of your consultation — unless you give specific consent. You should give consent for the assessment, and you can usually see the report before it goes to your employer, ask for factual errors to be corrected, attach your own comment, or withdraw consent so it is not released. Even if your employer is paying, you are not obliged to consent to the report being shared.
Under the Equality Act 2010, your employer must consider reasonable adjustments for a disability, and occupational health advice often helps them do this.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Management referral versus seeing your GP
| Feature | Management referral | Your GP |
|---|---|---|
| Main role | Advice on health and work | Diagnose and treat you |
| Acts for | You and the employer, impartially | You |
| Knows the job | Yes, in detail | Often only in outline |
| Output | Advice report on fitness/adjustments | Treatment and fit notes |
Occupational health understands your job and advises on work; your GP diagnoses and treats you. They work best together.
Preparing for your appointment
- Read the referral so you understand what your employer is asking and why.
- Check you have given consent and understand what the report may cover.
- Make a note of your symptoms, treatment, and how your health affects specific tasks.
- Think about adjustments that would help you stay in or return to work.
- Bring a list of your medicines and any relevant specialist letters or reports.
- Note any questions you want answered, including about confidentiality.
- Remember you can ask to see the report before it is sent to your employer.
What happens
You meet an occupational health nurse or doctor, in person, by video or by telephone. They confirm your consent and what the referral is asking, then discuss your health, your treatment and how it affects your work. There may be a relevant examination, though many assessments are a conversation.
The clinician forms an impartial opinion on your fitness for work, likely timescales and any adjustments that would help. They then write a report addressed to your employer's questions. The report focuses on work — fitness, timescales and adjustments — and keeps your clinical details confidential unless you consent to share more.
You can usually see the report before it is sent. You can point out anything factually wrong, attach your own comments, or withdraw consent so it is not released — though that may affect how your employer can support you. Because occupational health is impartial, the advice is meant to be fair to both you and the employer.
Is this appointment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- When you need diagnosis or treatment, which is for your GP or specialist, not occupational health.
- When the issue is purely an employment dispute better handled by HR, a union or legal advice.
- As a way to bypass reasonable adjustments rather than to plan them.
- Where urgent care is needed for an acute health problem.
Delay or rearrange if…
- You have not been given clear information or the chance to consent properly.
- Key specialist reports or records needed for sound advice are missing.
- You are acutely unwell or in crisis and need care first.
- Your situation is changing rapidly, so any advice would quickly be out of date.
Alternatives to discuss
- Your GP or specialist for diagnosis, treatment and fit notes.
- A direct conversation with your manager about adjustments where the issue is straightforward.
- HR, a union, ACAS or the EHRC for employment-rights questions.
- A sickness absence review where the focus is specifically on absence.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Gives your employer impartial, expert advice instead of guessing about your health.
- Helps secure reasonable adjustments and a safer return to work.
- Keeps your diagnoses confidential while still getting you support.
- Lets you put your own view across and see the report before it is shared.
- Can speed up a fair plan, whether that is staying in work, returning, or further support.
Risks & complications
- Feeling anxious or judged about discussing your health with someone arranged by your employer.
- A report that recommends changes you and your employer then need to agree.
- The report not saying what you hoped, because the advice must be honest and impartial.
- Needing a further specialist report before clear advice can be given.
- Disagreement about facts in the report, which you can comment on but not rewrite.
- Advice that your employer says it cannot fully act on.
- Concern about how the report will be used in a capability or absence process.
- Advice that you are not currently fit for your role, with implications you had not expected.
- A safeguarding or fitness-to-drive concern the clinician is obliged to act on.
The biggest worry people have is that occupational health is 'on the employer's side'. It is not — the clinician is impartial and must be honest to both of you. The main safeguards are your consent, your right to see the report before it is sent, and your right to comment on or withhold it. If your health relates to a disability, your employer must consider reasonable adjustments, and ACAS or the Equality and Human Rights Commission can advise if you feel the process is being misused.
Published figures to discuss
This is an advisory consultation, not a procedure, so there are no complication rates to quote. What varies is the advice given, which depends on your health, your job and the standards occupational health follows on impartiality, consent and confidentiality. Outcomes such as a successful return to work also depend heavily on the employer acting on the advice.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Confidentiality misunderstanding | Common | The employee should know what questions are being asked and what information will be shared. | Guide sourcesClinical context |
| Fitness advice based on incomplete role information | Recognised | Accurate job demands, hours, hazards and adjustments are needed for useful advice. | NICE NG146 — Workplace health: long-term sickness absence and capability to work (2019)nice.org.ukSource-linked context |
| Medicalising a workplace problem | Common pitfall | Conflict, workload, bullying or poor management may need workplace action as well as healthcare. | Guide sourcesClinical context |
| Unclear recommendations | Common report failure | Good reports distinguish diagnosis, functional impact, likely timescale, adjustments and review plan. | NICE NG146 — Workplace health: long-term sickness absence and capability to work (2019)nice.org.ukSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery. 'Afterwards' is about the report — what it advises, when you see it, and how it is used to plan your work.
- Feeling tired or emotional after talking about your health and work.
- Waiting a few days for the report to be written and shared.
- Being offered the chance to read the report before it goes to your employer.
- A meeting with your manager to agree the recommended adjustments.
Aftercare
- Read the report and check the facts before agreeing it can be sent.
- Keep a copy of the report for your own records.
- Discuss the recommended adjustments with your manager and confirm what will happen.
- Continue any treatment with your own GP or specialist alongside the work plan.
- Ask occupational health if you are unsure what was shared with your employer.
- Seek advice from HR, a union, ACAS or the EHRC if you feel the process is unfair.
- Attend any review appointment arranged to check progress.
- The referral letter and its questions
- Notes on how your health affects specific tasks
- Ideas for adjustments that would help
- Medicine list and relevant specialist letters
- Questions about confidentiality and consent
- A clear understanding of your right to see the report
⚠ Get urgent help if…
- Worsening of the condition affecting your work — seek medical care, not just an adjusted plan.
- New severe symptoms such as chest pain, breathlessness or sudden weakness — urgent help.
- Thoughts of harming yourself — get help now: call 999 or go to A&E if you are at immediate risk. For urgent support, use NHS 111 in England, Scotland or Wales; in Northern Ireland, contact your GP out-of-hours or your HSC Trust's Phone First service.
- Feeling pressured to consent to share more than you are comfortable with.
- A report being used in a way that ignores recommended reasonable adjustments.
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good outcome is clear, impartial, work-focused advice that helps you and your employer agree a fair and safe plan — whether that is staying in work with adjustments, a phased return, or further support. The report should answer the referral questions while protecting your clinical confidentiality.
The assessment does not diagnose or treat your condition, cannot force your employer to make every recommended change, and reflects your situation at the time. Its value depends on you and your employer acting on sensible advice and on adjustments being genuinely considered.
The advice reflects your health and your job at the time of the assessment. As your condition or role changes, a further referral or review may be needed. Adjustments often need monitoring and may be revised, so a single report is rarely the end of the conversation.
Related tests, treatments or support
A management referral often works alongside your GP's treatment and fit notes, and may follow or feed into a sickness absence review. For new starters, the equivalent is the pre-employment medical or pre-placement questionnaire, covered in the related guides. Occupational health and your treating clinicians have different roles and work best together.
Follow-up & long-term care
With your consent, the report goes to your employer, who should arrange a meeting to discuss adjustments. Occupational health may review you to check progress or as your health changes. Your own GP or specialist continues to manage the underlying condition.
- Attend review appointments to check how adjustments are working.
- Tell occupational health if your health or your role changes significantly.
- Keep records of the advice given and the adjustments agreed.
Repeat, follow-on and what comes next
- Advice and adjustments often need reviewing as your health or role changes.
- A report can be reissued if facts change, but cannot be rewritten to a preferred conclusion.
- You can attach your own comments to a report you disagree with, or withhold consent for release.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear, impartial report that answers the referral and protects confidentiality.
- An offer to see the report first, with a route to correct factual errors.
- A follow-up plan to check how adjustments and your health are progressing.
- Coordination with your GP or specialist, and signposting to support where needed.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether the assessment is with a nurse or a doctor, and its length.
- How complex your health and job situation is.
- Whether it is face to face, by video or by telephone.
- Whether a specialist report or further information is needed.
- How detailed the report and adjustment recommendations are.
- Whether follow-up reviews are arranged.
- What the assessment includes and who carries it out.
- Who receives the report and what information it will contain.
- That clinical details stay confidential unless you consent otherwise.
- That you will be offered the chance to see the report before it is sent.
- Turnaround time for the report.
- What happens, and any cost, if a further assessment, specialist report or review is needed.
On the NHS? Management referrals are an employer-arranged occupational health service, not NHS care that individuals can request for themselves.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not understanding that occupational health is impartial, not the employer's doctor.
- Not being clear what will be shared with the employer versus kept confidential.
- Not being offered sight of the report before it is sent.
- Feeling that paying employer means you must consent — you do not have to.
Marketing red flags
- Presenting occupational health as a tool to 'manage out' staff.
- Implying full clinical details will routinely be passed to managers.
- Downplaying your right to see the report or withhold consent.
- Treating reasonable adjustments as optional rather than a legal duty.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- What exactly is my employer asking you to advise on?
- What will the report say, and what will stay confidential?
- Can I see the report before it goes to my employer?
- What adjustments would you recommend to help me stay in or return to work?
- How will my consent, and any decision to withhold it, affect things?
- Will there be a follow-up to check how the plan is working?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my appointment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this appointment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is occupational health on my employer's side?
Will my employer find out my diagnosis?
Can I see the report before my employer does?
Do I have to attend if my employer arranged it?
Will the report decide whether I keep my job?
Is this an NHS service?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: Faculty of Occupational Medicine — Good Occupational Medical Practice ACAS — Reasonable adjustments at work GMC — Disclosing information for employment and insurance Society of Occupational Medicine — Work and health resources ACAS — Supporting disabled people at work NICE NG146 — Workplace health: long-term sickness absence and capability to work (2019) nidirect — Urgent and emergency care services nidirect — GP out-of-hours service
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
Related guides: Sickness absence review · Pre-employment medical · Pre-placement health questionnaire review · Sick notes and medical reports · Medico-legal and occupational health reports