Health surveillance is a legal requirement, but it’s also a structured clinical process.
Recently, we’ve seen instances where, following a health surveillance escalation, clients have asked whether an employee can simply be re-booked with a nurse rather than referred to an Occupational Health Physician (OHP).
In short: once escalation criteria are met, re-booking with a nurse is not the correct pathway.
This blog explains the difference between an OHP vs nurse review, why escalation matters, and what UK legislation says about employer and employee responsibilities.
What Is Health Surveillance?
The Health and Safety Executive (HSE) defines health surveillance as a system of ongoing health checks where employees are exposed to specific workplace risks, such as vibration, respiratory hazards, noise, or hazardous substances.
The purpose is to:
- Detect early signs of work-related ill health
- Prevent conditions from progressing
- Protect employees from further exposure
- Ensure employers meet their legal obligations
Health surveillance is underpinned by the Health and Safety at Work etc. Act 1974, which places a duty on employers to protect the health, safety and welfare of employees.
Importantly, surveillance is not just about conducting the initial test, it is about acting appropriately when concerns are identified.
The Role of the Occupational Health Nurse
Occupational Health Nurses play a vital role in delivering routine health surveillance. They are trained and competent to:
- Conduct structured assessments such as spirometry, audiometry and HAVS Tier 2/3
- Identify symptoms using approved protocols
- Recognise when results fall outside normal parameters
- Escalate cases where clinical thresholds are met
Nurses work within defined clinical frameworks. When those frameworks indicate escalation, it means the assessment has moved beyond routine screening.
At that stage, continuing with nurse-led appointments does not address the identified concern.
The Role of the Occupational Health Physician (OHP)
An Occupational Health Physician is a medically qualified doctor with specialist training in occupational medicine.
An OHP can:
- Diagnose work-related conditions
- Interpret complex or abnormal clinical findings
- Determine fitness for work in relation to specific exposures
- Advise on restrictions or adjustments
- Consider legal reportability (including RIDDOR where applicable)
- Provide medically defensible opinions
When a case reaches escalation, for example:
- HAVS Tier 4
- Abnormal spirometry results
- Symptoms suggestive of occupational disease
The matter moves from screening into medical assessment.
That assessment must be undertaken by an OHP.
Why Escalation Cannot Be Bypassed
When escalation criteria are triggered, it indicates that:
- There may be developing work-related ill health
- Ongoing exposure could pose further risk
- Medical interpretation is required
- There may be legal implications
Re-booking with a nurse does not remove the clinical concern. It simply delays appropriate medical review.
From a compliance perspective, failing to follow the escalation pathway could place employers at risk of:
- Not acting on identified health concerns
- Failing to meet regulatory expectations
- Increased liability should the condition worsen
Health surveillance must be a defensible and auditable process. That includes appropriate referral to an OHP when required.
Can Employees Refuse an OHP Review?
Under Section 7(b) of the Health and Safety at Work etc. Act 1974, employees have a duty:
“…to co-operate with [the employer] so far as is necessary to enable that duty or requirement to be performed or complied with.”
Where health surveillance is required by law, participation is not optional. Employees must co-operate with the process, including escalation to an OHP when clinically indicated.
This protects both the individual and the organisation.
Practical Examples
HAVS Tier 4
Tier 4 indicates significant symptoms potentially consistent with Hand Arm Vibration Syndrome.
At this stage:
- A nurse cannot diagnose HAVS
- Medical assessment is required
- Exposure restrictions may need consideration
- Legal reporting may be relevant
An OHP review ensures the case is managed appropriately and compliantly.
Abnormal Spirometry
Abnormal lung function results may suggest occupational asthma or other respiratory conditions.
Only an OHP can interpret these findings in the context of workplace exposure and advise on:
- Fitness to continue exposure
- Further medical investigation
- Necessary workplace controls
Why This Matters for Employers
Following the correct escalation pathway:
- Demonstrates compliance with HSE guidance
- Protects employee health
- Provides medically defensible documentation
- Reduces risk of future claims
- Supports informed management decisions
Health surveillance is not simply about completing tests, it is about acting appropriately on the results.
OHP vs Nurse Review – In Summary
Occupational Health Nurses deliver essential screening.
Occupational Health Physicians provide medical diagnosis and legally robust fitness opinions.
When escalation criteria are met, referral to an OHP is not an optional extra, it is the correct and necessary next step in a legally compliant health surveillance programme.