Thirdly, all participants discussed the current role of occupational health departments and opportunities for their involvement in a surveillance system of this kind. Participants criticised the lack of funding and resources supplied to these departments, which currently played a minor role in managing HCWs' health beyond initial employment screening. They felt occupational health departments would be well placed to manage symptom and personal health data and organise diagnostic testing, and were keen to see their function broaden, assisting with the management of acutely as well as chronically sick staff, and in particular those symptomatic in the work place. Further, they felt independent assessments of symptomatic staff by occupational health departments would make decisions to send staff home 'more valid' and minimise anxieties and scepticism (appendix 5). In all countries, participants described the current practice for sick HCWs to visit their own general practice doctors, highlighting the potential inability for these to identify unusual symptoms in the first instance and make time-spatial links with other possible cases. There was consensus on the need to expand standard management and control guidelines of infectious disease outbreaks in the work place beyond those for gastrointestinal infections. However, with occupational health departments struggling with current functions, such as promoting and providing seasonal influenza vaccinations, participants lacked confidence in the ability of these departments to manage staff with acute infections and perform epidemiological investigations. HCWs' perceptions of knowledge and structural barriers are presented in appendix 5.