Occupational Health and Pre-Employment Medicals in London 2026. What Employers Can Ask, What the Law Requires and How Referrals Work

Occupational health exists to answer one question, whether a person's health affects their work and whether their work affects their health, and getting the process wrong exposes employers to discrimination claims as well as lost time. Section 60 of the Equality Act 2010 prohibits employers from asking health questions before a job offer except in narrow circumstances, such as establishing whether reasonable adjustments are needed for the recruitment process itself or whether a candidate can carry out a function intrinsic to the role. Health assessment therefore belongs after a conditional offer, and the outcome should be a fitness opinion rather than a medical record. The same principle governs management referrals during employment. The employer asks specific questions, the employee consents, and the report answers the questions without disclosing clinical detail beyond what is necessary. The commercial stakes are clear. Sickness absence cost the UK an estimated 148.8 million working days in 2025, mental ill health accounts for 41% of long-term absence cases according to CIPD, and the cost of an absence tracks its length, so a referral answered in days rather than weeks is worth considerably more than one answered in a month. The Wellness provides pre-employment assessments, management referrals, return-to-work and fitness for role opinions, and statutory health surveillance for UK employers, with same-week appointments at 10 Portman Square, by video or at your premises. Fees appear further down this page.

Reviewed by the medical team at The Wellness. Last updated 25 September 2026.

Discuss occupational health on WhatsApp or email team@thewellnesslondon.com or call 020 3951 3429.

What employers can and cannot ask before a job offer

Before an offer, section 60 of the Equality Act 2010 limits health questions to specific permitted purposes. These include establishing whether a candidate needs reasonable adjustments to take part in the recruitment process, monitoring diversity, taking positive action, confirming whether a candidate can carry out a function that is intrinsic to the job, and cases where a genuine occupational requirement applies. General health questionnaires sent with application forms fall outside those purposes.

After a conditional offer, a health assessment is lawful and sensible where the role carries specific requirements. The assessment should focus on fitness for the particular job, identify any adjustments that would help, and produce an opinion rather than a diagnosis.

Some roles carry statutory or regulatory medical standards, including driving roles under DVLA group 2 standards, work at height, safety-critical roles, food handling and roles requiring health clearance for exposure-prone procedures in healthcare. Those assessments follow the applicable standard.

Withdrawing an offer on health grounds is lawful only where the condition would in fact prevent the person from doing the job even with reasonable adjustments, and doing so without a proper occupational health opinion is where many employers run into difficulty.

How a management referral should work

The referral letter does most of the work. It should describe the role and its demands, the absence or performance history, what the employer has already tried, and specific questions. Good questions are answerable. Is the employee fit for their role, and if not, when are they likely to be. What adjustments would help them return or remain at work. Is the condition likely to be a disability under the Equality Act. Is there an underlying medical reason for the attendance pattern.

The employee must be told why they are being referred and consent to the assessment and to the report being released. Under the Access to Medical Reports Act 1988, where a report is obtained from a doctor who has provided their care, they have rights to see it before it is sent, and good practice extends the same courtesy to occupational health reports.

The report answers the employer's questions in functional terms. It describes what the person can and cannot do, the likely duration, the adjustments recommended and the review date. It does not disclose a diagnosis or clinical detail unless the employee has agreed and it is necessary for the employer to act.

The decision on what adjustments are reasonable and on any employment action remains the employer's. Occupational health advises rather than decides.

Ask how to structure a referral on WhatsApp or email team@thewellnesslondon.com.

Return to work, fit notes and phased returns

The fit note allows a doctor to say an employee is not fit for work or may be fit for work with adjustments such as a phased return, altered hours, amended duties or workplace adaptations. Since July 2022 fit notes can also be issued by nurses, occupational therapists, pharmacists and physiotherapists, and they no longer need a handwritten signature. Since the Employment Rights Act 2025 removed the waiting days, statutory sick pay is payable from the first day of absence.

A fit note that says may be fit for work is advice to the employer rather than an instruction. Where the suggested adjustments cannot be accommodated, the employee is treated as not fit for work for that period.

An occupational health assessment adds what a fit note cannot. A plan for the return, a timeline for a phased increase in hours, specific adjustments tied to the role, and a review point. For musculoskeletal conditions, which made up 27% of work-related ill health in 2024/25 according to the Health and Safety Executive, and for mental health conditions, early assessment and a structured return are the interventions most associated with a successful outcome.

Health surveillance and statutory assessments

Some work legally requires health surveillance under health and safety law, where employees are exposed to a risk that can be monitored. Examples include noise under the Control of Noise at Work Regulations 2005, vibration, respiratory sensitisers and substances hazardous to health under COSHH, and some night work, where the Working Time Regulations 1998 require a free health assessment to be offered before night work begins and at regular intervals.

Display screen equipment users are entitled to an eye and eyesight test on request under the Health and Safety (Display Screen Equipment) Regulations 1992, with corrective appliances provided where they are needed specifically for screen work.

We arrange audiometry, spirometry, skin checks and other surveillance with the results recorded in the form employers need to meet their obligations, without disclosing clinical information beyond fitness conclusions.

What does occupational health cost in London

Occupational health providers typically charge £150 to £400 for a management referral report and £75 to £250 for a pre-employment questionnaire assessment, with face-to-face assessments and specialist reports priced higher. Retained occupational health contracts run into thousands per year before any referral is made. Private medical insurance for a workforce commonly runs £600 to £1,500 per employee per year, and multi-day executive programmes reach £14,000 per person.

At The Wellness each referral is quoted as one fee, with no retainer required. All figures are from prices, and corporate volume terms are available.

• Executive Health Programme for leadership, the most comprehensive single assessment, from £11,995.

• On-site clinic day at your premises for health surveillance, vaccinations or team checks, from £4,995.

• Disability status or complex occupational report for an employment dispute through the Medico-Legal Wing, from £1,950 plus VAT.

• Management referral with consultation, examination where needed and a written report answering the employer's questions, from £495.

• Return-to-work assessment with a phased return plan, from £395.

• Pre-employment medical following a conditional offer, including consultation and fitness opinion, from £295.

• Health surveillance, audiometry, spirometry and night worker assessments, quoted per cohort.

• Same-day GP care for employees from £150 by video and £220 in person, with fit notes issued in the appointment.

Appointments within the week at 10 Portman Square, Marylebone, by video, or at your premises across London.

Why The Wellness is the best choice for occupational health in London

Because referrals are answered in days rather than weeks, and the cost of an absence tracks its length.

Because reports answer the questions you asked in functional terms, with the adjustments specified and a review date set, so a manager can act on them without interpretation.

Because the law is followed properly. Pre-offer questions stay within section 60, consent is obtained and recorded, and clinical detail is not disclosed beyond what the employee has agreed and the employer needs.

Because assessment connects to treatment. Where a referral identifies something treatable, the employee can be seen by a GP the same week, with blood tests, imaging and specialist referral arranged, which shortens the absence rather than simply describing it.

And because the same organisation covers the whole range, from a pre-employment medical to a disability status report for a tribunal, so the evidence is consistent if a matter escalates.

Related reading

Corporate healthcare for UK employers covers firm-wide programmes, employment tribunal medical reports covers disability under the Equality Act, private sick notes and fit notes covers fit note rules, and private mental health care covers the largest cause of long-term absence.

Arrange a referral on WhatsApp or call 020 3951 3429.

Frequently asked questions

Can an employer ask health questions before a job offer

Only for limited purposes under section 60 of the Equality Act 2010, such as adjustments for the recruitment process or confirming a candidate can carry out a function intrinsic to the role. Broader health assessment belongs after a conditional offer.

What should a management referral include

A description of the role and its demands, the absence or performance history, what has already been tried, and specific answerable questions about fitness, likely duration, adjustments and whether the condition may be a disability. The employee must be told why and consent.

Will the employer see my medical details

No, unless you agree and it is necessary. The report answers the employer's questions in functional terms, describing what you can and cannot do, the likely duration and recommended adjustments, rather than disclosing diagnosis or clinical detail.

What is the difference between a fit note and an occupational health report

A fit note says whether someone is not fit for work or may be fit with adjustments. An occupational health report adds a return plan tied to the specific role, a phased timeline, detailed adjustments and a review point.

How much does an occupational health referral cost in London

Occupational health providers typically charge £150 to £400 for a management referral report. At The Wellness a management referral with consultation and written report is from £495, a return-to-work assessment from £395 and a pre-employment medical from £295, with volume terms and no retainer.

Do night workers need a health assessment

Yes. The Working Time Regulations 1998 require employers to offer night workers a free health assessment before they start night work and at regular intervals afterwards.

The Wellness is a doctor-led private healthcare group providing medical care from 10 Portman Square, Marylebone, adjacent to Harley Street. All doctors are GMC-registered. Occupational health opinions are advisory, and decisions on adjustments and employment remain with the employer. This article is general information and not legal or medical advice about a particular case.

Enquire now on WhatsApp or email team@thewellnesslondon.com or call 020 3951 3429.

References. Equality Act 2010, section 60 on enquiries about disability and health, and section 20 on reasonable adjustments. Access to Medical Reports Act 1988. Department for Work and Pensions guidance on the fit note, including 2022 changes to certifying professions and signatures. Employment Rights Act 2025, removal of statutory sick pay waiting days. Working Time Regulations 1998, regulation 7 on night worker health assessment. Control of Noise at Work Regulations 2005, Control of Substances Hazardous to Health Regulations 2002 and Health and Safety (Display Screen Equipment) Regulations 1992. Office for National Statistics sickness absence data 2025. CIPD Health and Wellbeing at Work report. Health and Safety Executive work-related ill health statistics 2024/25. Faculty of Occupational Medicine guidance on ethics and consent. Published 2026 UK occupational health market pricing.