Sickness absence review (Occupational health sickness absence assessment)
An impartial occupational health appointment, with your consent, to advise you and your employer on health-related absence and how to support a safe return 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 about health-related absence and a safe return to 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 meant to plan a fair return, not to rush you back or to manage you out.
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 absence.
When you need diagnosis or treatment, which is for your GP or specialist, not occupational health.
You discuss your health, absence and work, give consent, and explore a realistic return and adjustments.
A clear, impartial report that answers the referral and protects confidentiality.
You discuss your health, absence and work, give consent, and explore a realistic return and adjustments.
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 your return and any adjustments.
A phased return may begin, with a review to check how you are coping and whether adjustments are working.
What is a sickness absence review?
A sickness absence review is an occupational health appointment, usually arranged by your employer when you have been off sick or are absent often, to give advice about your health in relation to work and your return. It focuses on the work consequences of your health — likely timescales, what might help, and any adjustments — rather than on diagnosing or treating you.
Occupational health is impartial. The clinician advises both you and your employer and is not 'the employer's doctor'. The aim is a fair, realistic plan, not pressure to return before you are ready or a way to push you out.
Your clinical details stay confidential. The report normally gives advice on fitness for work, likely timescales and adjustments — not your diagnoses — unless you give specific consent. You give consent for the assessment, can usually see the report before it goes to your employer, can correct factual errors, attach your own comments, or withhold consent so it is not released. Even where your employer is paying, you are not obliged to consent to sharing the report.
Under the Equality Act 2010, your employer must consider reasonable adjustments where absence is linked to a disability, and occupational health advice often helps with this.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Sickness absence review versus a fit note from your GP
| Feature | Absence review | GP fit note |
|---|---|---|
| Main purpose | Plan a safe return | Certify you unfit for now |
| Acts for | You and the employer, impartially | You |
| Job knowledge | Detailed | Often outline only |
| Output | Advice on timescales and adjustments | A statement of fitness for work |
A fit note certifies your current fitness; an absence review advises on timescales and adjustments to help you return. They complement each other.
Preparing for your appointment
- Read the referral so you understand what your employer is asking about your absence.
- Check you have given consent and understand what the report may cover.
- Note your symptoms, treatment so far, and how your health affects specific tasks.
- Think about what would realistically help you return — and at what pace.
- Bring your medicine list, fit notes and any relevant specialist letters.
- Write down your questions, including about confidentiality and consent.
- 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 the reason for the review, then talk through your health, your treatment and how your absence relates to your work. There may be a relevant examination, but many reviews are mainly a conversation.
The clinician forms an impartial view of your fitness for work, likely timescales for return, and any adjustments or phased return that would help. They write a report answering your employer's questions, focused on work and keeping your clinical details confidential unless you consent to share more.
You can usually see the report before it is sent. You can correct factual errors, add your own comments, or withhold consent so it is not released — though this may affect how your employer can support your return. Because occupational health is impartial, the advice should be fair to both you and your employer, and should never pressure you to return before it is safe.
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 pressure an early return rather than to plan a safe one.
- 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 recovery is changing quickly, so any advice would soon be out of date.
Alternatives to discuss
- Your GP or specialist for diagnosis, treatment and fit notes.
- A direct return-to-work conversation with your manager where the situation is straightforward.
- HR, a union, ACAS or the EHRC for employment-rights questions.
- A broader management referral where wider health-and-work advice is needed.
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 absence.
- Supports a realistic, safe return at the right pace, with adjustments.
- 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 prevent an unsafe early return and reduce the risk of repeated absence.
Risks & complications
- Feeling anxious or under pressure when discussing absence with someone arranged by your employer.
- A report recommending changes that you and your employer then need to agree.
- The advice not matching what you hoped, because it must be honest and impartial.
- Needing a specialist report before clear advice can be given.
- Disagreement about facts in the report, which you can comment on but not rewrite.
- Advice your employer says it cannot fully act on.
- Worry about how the report fits into an absence or capability process.
- Advice that you are not fit to return yet, or that recovery is uncertain, with implications you had not expected.
- A safeguarding or fitness-to-drive concern the clinician is obliged to act on.
The main concern people have is being pushed back to work too soon or 'managed out'. A good occupational health clinician is impartial and should never pressure you to return before it is safe. Your safeguards are your consent, your right to see the report before it is sent, and your right to comment on or withhold it. Where absence is linked 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 unfair.
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 and how well a return goes, which depend on your health, your job, the standards occupational health follows, and crucially whether your employer acts on the advice and provides adjustments.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Physical harm from the review | None expected | This is an advisory consultation; harm comes from a poorly timed return or inadequate workplace plan. | Guide sourcesClinical context |
| Premature return leading to relapse or worsening symptoms | Condition- and job-dependent | A phased return, temporary restrictions and review dates are often safer than an immediate full return. | Guide sourcesClinical context |
| Overmedicalising a workplace problem | Recognised occupational-health pitfall | Bullying, workload, shift pattern, ergonomics or management issues may need workplace action rather than only medical treatment. | Guide sourcesClinical context |
| Inaccurate prognosis | Common uncertainty | Recovery timelines are estimates and should be updated if symptoms, treatment response or job demands change. | Guide sourcesClinical 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 shapes your return-to-work plan.
- Feeling tired or emotional after discussing your health and absence.
- 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.
- Starting a phased return and adjusting the plan as you go.
Aftercare
- Read the report and check the facts before agreeing it can be sent.
- Keep a copy of the report for your own records.
- Agree the return-to-work plan and adjustments with your manager.
- Pace your return as advised and flag early if it is too much.
- Continue treatment with your own GP or specialist alongside the work plan.
- Seek advice from HR, a union, ACAS or the EHRC if you feel the process is unfair.
- Attend any review arranged to check how your return is going.
- The referral letter and its questions
- Notes on symptoms, treatment and affected tasks
- Realistic ideas for a return and adjustments
- Medicine list, fit notes and 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 behind your absence — seek medical care, not just an earlier return.
- New severe symptoms such as chest pain, breathlessness or sudden weakness — urgent help.
- Thoughts of harming yourself — get help straight away: call 999 or go to A&E if you are in immediate danger; otherwise contact your GP, or NHS 111 in England, Scotland or Wales (in Northern Ireland, use your GP out-of-hours service or your HSC Trust's Phone First service).
- Feeling pressured to return before you are ready or to consent to share more than you wish.
- A return-to-work plan 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 realistic and safe return — at the right pace, with adjustments where needed. The report answers the referral while protecting your clinical confidentiality.
The review does not diagnose or treat your condition, cannot force your employer to make every recommended change, and reflects your situation at the time. A safe, lasting return depends on you and your employer acting on sensible advice and on adjustments being genuinely considered, not on being rushed.
The advice reflects your health and your job at the time of the review. As you recover or your situation changes, the plan often needs adjusting and a further review may help. A phased return is by nature temporary and should be revisited as you build back up.
Related tests, treatments or support
A sickness absence review works alongside your GP's treatment and fit notes, and may follow or lead to a broader management referral. For new starters, the equivalent is the pre-employment medical or pre-placement questionnaire. These are covered in the related guides, and occupational health and your treating clinicians work best together.
Follow-up & long-term care
With your consent, the report goes to your employer, who should arrange a return-to-work discussion. Occupational health may review you to check how the return and adjustments are working, or as your health changes. Your own GP or specialist continues to manage the underlying condition.
- Attend review appointments to check how your return and adjustments are going.
- Tell occupational health if your health changes or the plan is not working.
- Keep records of the advice given and the adjustments agreed.
Repeat, follow-on and what comes next
- Return-to-work plans and adjustments often need revising as you recover.
- A report can be reissued if facts change, but not 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 phased, monitored return with a review to check how you are coping.
- 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 absence 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 return-to-work plan 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 review or specialist report is needed.
On the NHS? Sickness absence reviews 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 is 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
- Framing absence reviews as a way to 'manage out' staff or rush returns.
- 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 about my absence?
- What will the report say, and what will stay confidential?
- Can I see the report before it goes to my employer?
- What would a safe, realistic return look like, and what adjustments would help?
- How will my consent, or any decision to withhold it, affect things?
- Will there be a review to check how my return is going?
- 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
Will occupational health force me back to work before I'm ready?
Will my employer be told my diagnosis?
Can I see the report before my employer does?
Do I have to attend if my employer arranged it?
Could this be used to dismiss me?
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 — Disability-related absence ACAS — Reasonable adjustments at work GOV.UK — The fit note: guidance for patients and employees Society of Occupational Medicine — Work and health resources nidirect — Urgent and emergency care services (NI) nidirect — GP out-of-hours service (NI)
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: Management referral assessment · Sick notes and medical reports · Pre-employment medical · Pre-placement health questionnaire review · Medico-legal and occupational health reports