Opinion: Why can’t OH nurses refer employees directly to the NHS?

Occupational health professionals should be allowed to refer patients to NHS specialist services. This would alleviate the pressure on GP surgeries and speed up treatment for employees, argues Rosalyn Jones

A question has been bugging me: why can’t occupational health practitioners refer to specialist departments in the NHS?

I have asked this question many times, particularly since the Covid-19 pandemic and in light of the problems many employees have obtaining a GP appointment or report.

The answer seems to be that most occupational health services are not associated with the NHS. This is not because of bias – it is just how things have always been.

I recently spoke to a secretary at the local NHS hospital and she concurred with what I am always told: the individual can only be referred by their own GP. So why is there so much difficulty, or reticence, to approach their GP?

It takes a lot of time just to make that initial contact with a GP surgery. Many patients have to call at 8am just to get through to the receptionist, and then they will have to wait for a call back to be offered an appointment in person or over the phone. Sometimes the process can take hours, which is difficult for most working adults to fit into their schedules.

I have been told by employees in manufacturing, construction, teaching and nursing that they simply cannot telephone their GP in the morning because of their work commitments. Many employees in these roles are unable to use their mobile phones in the workplace, and permission is often required before they can have their phones with them.

These barriers to obtaining an appointment, and being able to attend one when it is offered, can put individuals off approaching their GP. I worry about the consequences of this.

Our role as nurses

The NMC code of practice states that nurses must put the interests of people using or needing nursing or midwifery services first; must make their care and safety their main concern; must make sure that their dignity is preserved; and must ensure their needs are recognised, assessed and responded to.

The areas of the code that I feel apply to the issue of NHS referrals are: “work co-operatively”, “recognise and work within the limits of your competence” and “act without delay if you believe that there is a risk to patient safety or public protection”. Surely by not allowing OH nurses to refer employees directly to the NHS, we’re not upholding these parts of the code?

Yes, we can write to the individual’s GP and I suppose this has covered our duty to prioritise the needs of the person before us, but the frustrating part is whether this is followed up and the length of time it takes to have any diagnosis or treatment.

Long waits for NHS services

Many individuals are reporting that their appointments and surgeries have been cancelled, and not just once. This then has an impact at work – time off, financial implications, anxiety and stress.

Another worrying area is the length of time it takes for a medical report to be sent back to OH from the individual’s GP. I have experienced some medical practices that prioritise NHS work first. Again, because our OH service is not NHS-driven, some are delaying the issuing of these reports. This could be detrimental to the individual if there are any health or underlying issues to be navigated in the workplace.

The General Medical Council’s ethical guidance on disclosing information for employment, insurance, and similar purposes details how a doctor should respond to such requests; it does not say to concentrate on NHS work first.

Another issue is extensive waiting lists for NHS treatment. Some individuals have advised me that they will have to wait as long as 12 months for a hip replacement, or 35 weeks for a non-urgent neurological appointment. This length of time beggars belief, and leaves me questioning why this area of medicine is treated as non-urgent.

OH professionals could help

If the individual is being referred to a specialist and the referral form needs to be triaged, I would like to know why only an NHS GP is allowed to do this? Why is a competent, qualified medical person like an OH nurse not allowed to complete a referral form?

Allowing OH professionals to refer individuals to the NHS would provide a quicker and more efficient solution than the current situation, where the employee has to leave their OH consultation, get an appointment with their GP – which may take weeks – and then wait to be referred.

It appears the situation has worsened since the Covid-19 pandemic, and a recent news article on the BBC put the issue into the spotlight: a patient saw eight GPs before his cancer was spotted. This article mentions a patient safety watchdog, the Health Services Safety Investigations Body, which was recently launched and will be investigating NHS care in GP practices and the independent healthcare sector.

Of course, workloads and staffing shortages in GP surgeries could be driving the delays. A recent Royal College of General Practitioners report set out recommendations for the government to tackle the crisis and support GPs and their teams to meet the healthcare challenges of the 21st century. The recommendations included the development of a properly funded plan to enable general practice to respond to surges in demand; greater investment in IT systems; rolling out new, properly-funded GP retention schemes; and slashing unnecessary box-ticking requirements and workload so that GPs can focus on patient care.

OH professionals have huge expertise and we could be utilised as a pathway for signposting or referring patients for NHS care. Like doctors and nurses employed by the NHS, we are all qualified medical professionals following the NMC and GMC codes of conduct.

This is not a criticism of the dedicated staff in the NHS who work very hard to help patients; this is just an offer of potential help and a reflection of the issues faced by a hard-working OH professional.