The Good Day Problem: Your OH Assessment Guide

By Brian Berry, Owner and Founder of Leap Forward Careers. Last reviewed: September 2026. General information, not legal advice.

Your occupational health appointment is booked for next Tuesday. Here is the question nobody asks you: will Tuesday be a good day or a bad one?

If you have an occupational health assessment and a fluctuating condition, that question matters more than most people realise. An occupational health (OH) assessment sees you for about an hour. Your condition lives with you every day of the month. When the appointment lands on a good day, the report can describe someone who needs no support. Then the flare arrives, and your manager holds a report that no longer fits.

I call this the good day problem. This guide shows you how to make sure OH sees your whole month, not just one morning.

Why a Good Day Can Work Against You

Rheumatoid arthritis, lupus, Crohn’s disease, ME/CFS, endometriosis and severe asthma share one thing. They change. You might manage a full week with no trouble, then lose three days to a flare. Fatigue can build across a month instead of showing up on cue.

An OH appointment is fixed. It lands wherever the diary puts it. On a good day, you arrive on time, speak clearly and describe your job with confidence. The clinician writes what they see and answers the questions the referral asked. The report may say: fit for work, no adjustments required at present.

That sentence can follow you. It sits in your file when the next flare hits and your absence record starts to climb.

The government’s own example shows how this plays out. Its September 2026 Keep Britain Working update describes a composite employee with Crohn’s disease. She takes 22 days of absence in short spells over two years. None of those spells is long enough to trigger support, only the attendance policy. She moves into a capability process and leaves before it ends. The government says its examples draw on real experiences but do not describe a specific person.

How many of your absences last year were short spells that nobody linked together?

My Own Occupational Health Assessment

I am not writing this from the outside. I live with severe asthma. During Covid, I went through an OH assessment to decide whether I could work from home. The report confirmed my asthma and advised that I should work from home, because I was medically vulnerable.

That assessment worked for me. It confirmed my condition and gave my employer clear advice it could act on. That is what OH is meant to do.

Plenty of people with fluctuating conditions have a different experience. In a 2023 Business Disability Forum survey, only 27% of OH users with a long-term health condition felt OH helped their manager understand how to support them. Just 22% said it helped them manage their condition at work. Why the gap? In my view, it is often less about the clinician. It is more about the questions the referral asks and the evidence on the desk that day.

What Occupational Health Is For

OH is a health advice service, usually paid for by your employer. A doctor or nurse assesses how your health affects your work and what might help. With your consent, they send that advice to your employer.

The key word is advice. In Gallop v Newport City Council (2013), the Court of Appeal said an employer must make its own judgement about whether an employee is disabled. It cannot simply rubber stamp the OH opinion.

Two things follow. First, a report that misses your bad days is not the final word. Second, your own evidence matters, because your employer should weigh it alongside the report.

OH clinicians also follow professional ethics. Doctors follow General Medical Council (GMC) guidance, and OH nurses follow guidance from their own professional bodies. That shapes what you can ask for, which I cover below.

The Law Already Counts Your Bad Days

Under the Equality Act 2010, you are disabled if you have a physical or mental impairment with a substantial and long-term adverse effect on your ability to carry out normal day-to-day activities.

Here is the part that matters for fluctuating conditions. If the effect stops but is likely to come back, the law treats it as continuing. “Likely” does not mean more likely than not. In SCA Packaging v Boyle (2009), the House of Lords said it means something that could well happen.

The government’s statutory guidance on the definition of disability uses rheumatoid arthritis as its example. A person may have substantial effects for a few weeks, followed by a period of remission. If the effects are likely to recur, they count as continuing. The guidance also names conditions with fluctuating or recurring effects, including rheumatoid arthritis, ME, chronic fatigue syndrome, fibromyalgia, depression and epilepsy.

One more detail makes your records important. Whether an effect is likely to recur is judged on the evidence available at the time, not on what happens afterwards. A clear record made now is far easier to rely on than memory pieced together later.

There is a knowledge point too. Say OH learns about your disability while acting for your employer. The Equality and Human Rights Commission’s Employment Code says your employer will not usually be able to claim it did not know.

Your Rights Before the Appointment

Do you have to go?

An OH referral needs your consent, and you can say no. Refusing has a cost, though. Your employer can then act on the information it already has, which means decisions made without the full picture. For most people, attending and controlling the evidence is the stronger position. If your contract says something specific about medical assessments, check it.

Ask to see the referral questions

The report answers the questions it receives. Ask HR or your manager for a copy of the referral before it goes. If it only asks whether you are fit for work, ask them to add questions about the pattern. How often do flares happen, and how long do they last? How does a bad day affect the tasks in your job? Are the effects likely to recur? When should the advice be reviewed?

Can you bring someone?

There is no legal right to be accompanied at an OH appointment. The statutory right to be accompanied covers disciplinary and grievance hearings. You can still ask. Does your condition affect how you communicate, remember details or cope with stress? Then you can ask for a companion as a reasonable adjustment.

Ask for an appointment that suits your condition

You can ask for a phone or video appointment, a time of day that suits your symptoms, or breaks. Put the request in writing so there is a record.

Build Your Bad Day Evidence

The clinician sees one day. Your job is to bring the other days with you. You do not need medical training for this. You need a simple, honest record.

• A flare log. Note the date, how long the flare lasted, what you could not do and what helped. A few weeks of entries starts to show a pattern.
• Your absence pattern. List short absences over the past year. Spells of one or two days often tell a clearer story together.
• Letters from your GP or specialist. Include recent changes to treatment or medication.
• The tasks that fail on bad days. Use your job description and name the tasks: early starts, long meetings, screen work, lifting, travel.
• What helps. Later starts, home working on bad days, breaks, a phased return. Note what has worked before.

The builder below turns all of this into a one-page summary you can take into the appointment.

Good Day, Bad Day Builder

How to Describe a Bad Day in the Room

Many people play down their symptoms in the room. It is a habit built from years of getting on with things. In an OH assessment, that habit works against you.

Try describing three kinds of day:

1. A usual day. What you manage, and what it costs you.
2. A flare day. What you cannot do, and for how long.
3. A recovery day. What the days after a flare look like.

Here is an example of how that might sound:

On a usual day I work a full day. About twice a month I have a flare that lasts two or three days. During a flare I cannot start before 10am, and I lose concentration after an hour of screen work. The day after, I am slower but I can work from home.

If you feel well on the day, say so directly: “Today is a good day. I want the report to reflect the days that are not.”

Be accurate. Do not exaggerate, and do not play it down. The goal is a report that describes your real working life. Before you leave, ask the clinician whether the report will cover how often the effects recur. If the referral did not ask, the report may not say.

If the clinician only wrote down what they saw today, what would they miss?

Seeing the Report Before Your Employer

Ask this before the appointment ends: can I see the report before it goes to my employer?

GMC guidance says doctors should usually offer to show you the report, or give you a copy, before it is sent. OH nurses follow a similar approach under guidance from the Faculty of Occupational Health Nursing.

You may have heard of the Access to Medical Reports Act 1988. It gives you a legal right to see a report before it is sent. But it only covers a doctor who is or has been responsible for your care, such as your GP or a treating specialist. Most OH reports fall outside it, and reports written by nurses are not covered at all.

If your employer asks your GP or specialist for a report, the Act does apply. Your employer needs your written consent and must tell you about your rights. You can ask to see the report before it is sent, and you then have 21 days to arrange access. You can ask for corrections or add your own statement. If you did not see it beforehand, you can ask for a copy up to six months after it was supplied.

Can you stop an OH report being sent? Under GMC guidance, you can withdraw your consent after reading it. Think carefully first. Without the report, your employer can act on what it already knows, and the GMC notes that this can put you at a disadvantage.

When the Report Says Fit but You Are Not

A report that says fit for work is not a verdict. Here is what to do.

1. Check the facts. Dates, job title, tasks, symptoms and how often flares happen. Under GMC guidance, doctors should correct errors of fact and any opinion based on those errors.
2. Put your view in writing. Send HR or your manager a short note explaining what the report missed. Attach your flare log and any letters.
3. Ask OH to answer what it did not. If the report is silent on recurrence or bad days, ask your employer to send follow-up questions.
4. Ask for a review date. A first set of adjustments can run as a trial and be reviewed after a full flare cycle.
5. Ask how the decision was reached. Your employer should weigh the report against your evidence. Asking for its reasoning in writing is reasonable.
6. Get support early. A trade union rep, Acas or Citizens Advice can help. If a formal dispute looks likely, speak to an employment solicitor quickly, because tribunal time limits are short.

Absence Triggers and Adjustments

Short, repeated absences are the typical pattern of a fluctuating condition. Many attendance policies count exactly that pattern. This is where the good day problem does the most damage.

The duty to make reasonable adjustments can apply to attendance policies. In Griffiths v Secretary of State for Work and Pensions (2015), the Court of Appeal accepted that the duty applied when a disabled employee’s absence triggered a warning. Ms Griffiths lost on the specific adjustments she asked for, so nothing here is automatic. It does mean you can ask for disability-related absence to be recorded separately, or for trigger points to change. Your employer must consider the request.

Adjustments that suit fluctuating conditions tend to flex:

• a later start during a flare
• home working when symptoms peak
• a phased return after a longer episode
• an agreed way to report a flare without explaining it every time
• a review date to check the plan works

Do not wait to be offered. In the same Business Disability Forum survey, 78% of disabled employees said they had to start the adjustments process themselves. My guide on how to request reasonable adjustments at work shows you how to put the request in writing.

One recent change helps too. Since 6 April 2026, under the Employment Rights Act 2025, statutory sick pay has been payable from the first day of sickness absence instead of the fourth. For people whose flares cause one-day or two-day absences, that matters.

What Keep Britain Working Could Change

The government is working on a new approach to health at work. Its Keep Britain Working update, published in September 2026, describes a workplace conversation about what makes work difficult, what a good or bad day looks like, and which adjustments could help. That is the good day problem, named in government policy.

The update lists commitments being tested with a group of Vanguard employers. These include a conversation within five working days of an issue being raised, and a stay-in-work plan with named actions and review points. It also says employees should not be expected to disclose unnecessary personal information.

These are proposals being tested, not legal rights. They still give you language you can use now. Try asking your manager: “Can we talk about what a good day and a bad day look like for me?” That is the conversation the government wants to become normal.

Timing matters as well. According to the same update, someone absent for four to six weeks has a 96% chance of returning to work. After a year, fewer than half return. Early, accurate advice protects your job.

Your Before, During and After Checklist

Free Guides and Further Reading

Know someone with an OH appointment coming up? Send them this guide.

Occupational Health and Fluctuating Conditions: FAQs

Sources

• Equality Act 2010, section 6 and Schedule 1.
• Guidance on matters to be taken into account in determining questions relating to the definition of disability, Office for Disability Issues.
• SCA Packaging Ltd v Boyle [2009] UKHL 37.
• Gallop v Newport City Council [2013] EWCA Civ 1583.
• Griffiths v Secretary of State for Work and Pensions [2015] EWCA Civ 1265.
• Equality and Human Rights Commission, Employment Statutory Code of Practice (2011).
• Access to Medical Reports Act 1988.
• GMC, Confidentiality: disclosing information for employment, insurance and similar purposes.
• Business Disability Forum, Great Big Workplace Adjustments Survey 2023, also cited in the Fabian Society report Nye’s Lost Legacy (2025).
• Keep Britain Working: a national growth opportunity (September 2026).
• Employment Rights Act 2025, statutory sick pay changes in force from 6 April 2026.