Issue date
26 Sep 2016

Medical referrals in employment - Is the Doctor appropriately qualified?

A short guide for employees and their representatives

Workers can be referred to a doctor by their employer for a number of reasons. It can be for an examination at pre-employment, prior to change of job; to support access to rehabilitation or treatment, to check their medical 'capability' to work after an illness or injury, or as part of a regular health screening.

If referrals are through an occupational provider then you may not know who the doctor will be, or it could be a nurse or physiotherapist, but the provider should be properly accredited. You can find out how to check if it is here.

Often employees are confused about the types of doctors, (and other practitioners) and what their different roles are.

Only someone on the General Medical Council medical register can practice medicine in the UK. Legally, doctors can only practice if they are on this list. They will have a medical degree and will be able to diagnose and treat patients, including prescribing medication. They will not however necessarily be competent to deal with any specialist area. The GMC also has an additional register of General Practitioners (GPs) which is those doctors who have skills specifically in general practice.

However, anyone on the medical register can, not only practice medicine, but can offer their services as an expert or adviser and seek referrals from employers or insurers. Many of those doctors who practice in occupational medicine, dealing with capability assessments, and other medical reports, have had no specialist training and may have only limited knowledge of many of the areas that they should be dealing with such as the health problems of hazards in the workplace, rehabilitation to work or adjustments at work.

Specialist doctors

Specialists are doctors who have had extra training in health problems in one area of medicine. The term 'specialist' has a legal meaning. A doctor cannot call themself a 'specialist' unless they are on the GMC 'specialist register'. No doctor should call themselves a 'consultant' unless they are on the specialist register in the appropriate field of medicine. This register states in which field the particular doctor is qualified to practice as a specialist.

To check if a doctor is able to practice and whether they have a specialist qualification go to:

http://www.gmc-uk.org/register/index.asp

Other Professionals

Often an employee will be referred to a non-medical practitioner, such as a physiotherapist, nurse or podiatrist. Non-doctors are not on the GMC register, but, in most cases, they must be registered with their own professional bodies to practice their profession. Non-medical practitioners are an important part of health care and a referral to one of these should not be seen as 'second best' however, generally such professionals can only assess and treat specific injury or illness, rather than diagnose. In many situations they will 'operate' under the direction of a doctor.

Occupational health doctors

In occupational health there are many doctors who provide occupational health services who are not 'specialists'. In some cases, they may be quite capable of dealing with an issue, but it is important that the employees referred to them know what to expect and what the various qualifications mean and they can expect.

A specialist in occupation medicine will normally be either a member or fellow of the Faculty of Occupational Medicine and will have either MFOM or FFOM after their name. They will be on the GMC specialist register, as occupational medicine specialists, and are judged to be 'fully knowledgeable in occupational medicine theory practice and delivery'. They will all have completed the full approved training in occupational medicine.

Some practitioners will also hold a qualification of AFOM, which is being phased out but which showed the doctor had a core knowledge in occupational medicine. They will also have broad-based clinical experience. Although they are not 'specialists' they would be able to deal with most, except the most challenging, situations.

In addition, there are other medical practitioners with a special interest in occupational medicine who are not specialists, but have had some training. Often these are GPs. If they have the Diploma in Occupational medicine (DOccMed), they will have undertaken training, which allows them to give basic day to day advice and will have some understanding of the issues that affect health and work. They will be able to do health assessments etc., but would need to consult a specialist in many more complex situations.

The HSE have recommended that the minimum standard for those who work in occupational medicine should be the Diploma in Occupational Medicine.

If a medical practitioner does not have any of these qualifications (DOccMed, AFOM, MFOM or FFOM), it is likely that they only have the minimal training in occupational medicine, which most, but not all, doctors get at medical school (a few hours worth). They do not have the qualifications, confirmed experience or ongoing checks of their work that would enable an employer or a worker to be confident of their competency in this field.

Other fields

In many cases an employer or a GP may refer an employee to a specialist in another field such as chest medicine, dermatology or rheumatology. This can be totally appropriate, however, once again, the employer should check whether the person is on the GMC specialist register for that specialty.