SME Access to Occupational Health: UK Report
Small and medium-sized businesses consistently struggle to access Occupational Health (OH) support. The UK Government's Understanding Occupational Health Provision 2023–24 report helps explain why. For SMEs trying to manage sickness, reduce absence and support staff fairly, these findings are relevant. This article summarises the key evidence, explains what it means for SMEs and why early intervention matters.
- £200 max cost per OH assessment
- ~40% of providers had unfilled vacancies
- SMEs significantly under-represented in OH use
SMEs Are Under-Represented in Occupational Health Use
The report is clear:
"SMEs continue to be significantly under-represented in the customer base."
WP/DHSC, 2025, p. 6
Despite having the same legal duties as large employers, SMEs access OH far less often. This creates a structural disadvantage in managing health-related issues, especially long-term sickness.
Cost and Awareness Are the Biggest Barriers
The Government identifies two dominant obstacles:
"The challenges with working with SMEs were mainly financial… along with lack of awareness among SMEs of the benefits of OH."
DWP/DHSC, 2025, p. 6
Financial barriers
OH assessments typically cost £51 to £200 per person (DWP/DHSC, 2025, p. 5). This is a significant expense for small businesses.
Awareness barriers
Many SMEs:
- Don't know when OH should be used
- Don't understand the return-on-investment
- Aren't sure how to commission OH support
This aligns with HSE findings that SMEs often lack confidence in managing workplace health risks (HSE, 2023).
Providers Are Operating at or Above Capacity
The report states:
"OH providers… reported having been working near their maximum capacity, at maximum capacity or above full capacity."
DWP/DHSC, 2025, p. 4
With limited capacity, providers naturally prioritise larger clients. Even when SMEs want OH support, they may face long waits. This can undermine early intervention and prolong absence.
Workforce Shortages Limit Access Further
The report highlights shortages in:
- OH nurses (SCPHN)
- Physiotherapists
- GMC registered Occupational Medicine specialists
Nearly 40% of providers had unfilled vacancies. The Faculty of Occupational Medicine has repeatedly warned that workforce shortages restrict the availability of high-quality OH services (FOM, 2019).
This means access challenges will persist for years, and prices are unlikely to fall.
Why Early Intervention Matters for SMEs
Because traditional OH access is limited, SMEs must rely more heavily on manager-led early intervention.
NICE guidance supports early action
NICE recommends:
- Early, work-focused conversations
- Temporary adjustments
- Maintaining contact during sickness absence (NICE, 2019)
These steps help prevent short-term issues from escalating.
HSE emphasises early action on workplace stressors
The HSE Management Standards highlight six key factors: demands, control, support, relationships, role and change. They stress the importance of addressing concerns early to prevent work-related stress (HSE, 2023).
Faculty of Occupational Medicine: Early, Proactive Support Is Essential
The Faculty of Occupational Medicine (FOM) strongly emphasises the importance of early, proactive action by employers to prevent avoidable long-term sickness absence. In its response to the Keep Britain Working Review, FOM highlights that:
- Good work is beneficial for health, and remaining connected to work supports recovery.
- Early intervention by employers is critical to preventing short-term issues from becoming long-term problems.
- Timely access to occupational health advice improves outcomes and reduces the risk of prolonged absence.
- SMEs face particular challenges in accessing OH, reinforcing the need for practical, scalable support.
These points directly align with the Government's Keep Britain Working Review (Final Report), which highlights:
- The importance of early, work-focused support to prevent long-term absence.
- The need for better access to occupational health, especially for SMEs.
- The role of employers in maintaining contact and offering adjustments during sickness absence.
- The wider economic impact of prolonged absence and workforce disengagement.
Together, the FOM response and the Government review provide a consistent evidence base: early intervention, good work, and accessible occupational health are central to improving workforce health and reducing avoidable absence.
FOM's position aligns directly with NICE and HSE guidance: employers should act early, maintain communication, and provide temporary adjustments wherever possible to support recovery and return to work.
With OH capacity constrained, early intervention becomes the most reliable tool SMEs have.
Conclusion: SMEs Need Practical, Low-Cost Support Now
The Government's 2023–24 OH Provision report confirms that SMEs face significant barriers to accessing Occupational Health, including cost, limited awareness, workforce shortages and provider capacity constraints.
Where traditional OH access is difficult, early intervention can help managers respond before a concern becomes harder to manage. NICE, HSE and FOM guidance all support early conversations, temporary adjustments and proportionate management.
SMEs need clear, low-cost, practical tools that help managers consider an early response while recognising when external support is needed. OH Sam provides a self-serve starting point for this work.
References
- Department for Work and Pensions (DWP) (2024) Keep Britain Working Review: Final Report. Available at: https://www.gov.uk/government/publications/keep-britain-working-review-final-report/keep-britain-working-final-report
- Department for Work and Pensions & Department of Health and Social Care (DWP/DHSC) (2025) Understanding Occupational Health Provision 2023–24. London: UK Government. Available at: https://www.gov.uk/government/publications/understanding-occupational-health-provision-2023-24
- Faculty of Occupational Medicine (FOM) (2024) Faculty of Occupational Medicine Response to the Keep Britain Working Review: Final Report. Available at: https://www.fom.ac.uk/general-news/faculty-of-occupational-medicine-response-to-the-keep-britain-working-review-final-report
- Health and Safety Executive (HSE) (2023) Managing the Causes of Work-Related Stress: The Management Standards. Bootle: HSE. Available at: https://www.hse.gov.uk/stress/standards/
- National Institute for Health and Care Excellence (NICE) (2019) NG146: Workplace Health: Management Practices. London: NICE. Available at: https://www.nice.org.uk/guidance/ng146
Frequently Asked Questions
What does the 2023–24 Government report say about SME access to occupational health?
The report confirms that SMEs are significantly under-represented in the occupational health customer base. Despite having the same legal duties as large employers, small businesses access OH far less often due to cost, lack of awareness, provider capacity constraints, and workforce shortages.
How much does an occupational health assessment cost in the UK?
According to the DWP/DHSC 2025 report, OH assessments typically cost between £51 and £200 per person. This is a significant expense for small businesses operating with tight margins.
Why is early intervention important for SMEs managing sickness absence?
Because traditional OH access is difficult and expensive for SMEs, manager-led early intervention becomes essential. NICE, HSE, and the Faculty of Occupational Medicine all recommend early, work-focused conversations, temporary adjustments, and maintaining contact during sickness absence to prevent short-term issues from escalating into long-term problems.
Are occupational health providers at capacity in the UK?
Yes. The Government's 2023–24 report found that OH providers were working near, at, or above maximum capacity. With nearly 40% of providers reporting unfilled vacancies in OH nursing, physiotherapy, and occupational medicine, access challenges are likely to persist for years.
What guidance does NICE give on workplace health for SMEs?
NICE guideline NG146 (Workplace Health: Management Practices, 2019) recommends early, work-focused conversations, temporary workplace adjustments, and maintaining contact during sickness absence. These steps help prevent short-term health issues from escalating into long-term absence.
OH Sam is a self-serve tool for practical workplace health advice and support. It does not replace clinical, legal or specialist occupational health advice.