Pre-employment medicals: what they involve and what employers can ask

A pre-employment medical, or work health assessment, is a process to assess whether a person will be in a suitable role and working environment. NHS Employers, writing about NHS recruitment, says its primary purpose is to help prevent work-related illness, injury and the spread of disease or infection. The extent of the assessment depends on the requirements and risks of the role and on the effect on the health of the worker and of anyone they might have contact with, such as patients.

In many workplaces the assessment is a short questionnaire reviewed by an occupational health professional. In others, for example roles with specific risks, further checks such as vaccinations or screening may be needed. NHS Employers notes employers have discretion to carry out further supplementary screening depending on local needs and the risks of the role, which must still comply with the Equality Act.

Section 60 of the Equality Act 2010 provides that a person to whom an application for work is made must not ask about the health of the applicant before offering work, or before including the applicant in a pool of candidates from whom they intend to select someone. The Act defines offering work as making a conditional or unconditional offer.

There are narrow exceptions. A question may be asked where necessary to establish whether the applicant can comply with a requirement to undergo an assessment (or to find out whether adjustments are needed for it), whether the applicant can carry out a function that is intrinsic to the work, to monitor diversity among applicants, to take positive action for disabled people, or where a particular disability is an occupational requirement.

NHS Employers says assessments should take place after an offer of employment but before the employment, placement or training begins, and that employers must make clear that the offer is conditional on pre-appointment checks, including a work health assessment.

As an example of a common process, NHS Employers suggests that a conditional offer letter is accompanied by a separate form on which the individual ticks one of two statements: either that they are not aware of a health condition or disability that might impair their ability to carry out the duties, or that they have a health condition or disability that might affect their work and may require adjustments. Whichever is ticked, the occupational health practitioner decides whether there are any additional requirements or adjustments to consider, and complex cases may be seen by the occupational health service.

Occupational health then sends a clearance certificate to human resources confirming that the person can start work, or can start work with reasonable adjustments, and noting any immunisation or exposure-prone-procedure clearance where applicable. If no recommendations are made, the process ends and the appointment is confirmed.

The Equality Act places a duty on employers to make reasonable adjustments for applicants or employees with a disability. NHS Employers lists examples, including practical changes to premises, altering working hours, allowing absences for medical treatment, additional training, special or modified equipment, changed instructions or manuals, and additional supervision and support. It says that in most cases adjustments are easy and inexpensive to implement.

Employers may also consider the Access to Work scheme, which can provide financial assistance. It is the individual who applies to the scheme, so it is something to discuss with the employer.

For healthcare workers, NHS Employers explains that immunisation requirements depend on the role and the exposure risks, following the Green Book. Workers carrying out exposure prone procedures have a professional duty to be tested and assessed for HIV, hepatitis B and hepatitis C, with testing only with informed consent. Other roles may involve checks relevant to the hazards, which must be job-related.

NHS Employers says occupational health has a duty to provide specialist and confidential advice to both the prospective employee and the employer, and that health assessment information should be held separately from the personnel record, accessible only by the occupational health service. Reports or summaries may be held on the personnel record where that has been agreed with the individual.

The decision to appoint sits with the recruiting manager, who should have considered all relevant information and any adjustments. According to the same standard, no individual should be refused employment on health grounds unless expert occupational medical advice has been sought, the applicant has had the opportunity to discuss the issues with an occupational health professional and the manager has given full consideration to the facts. Legally, asking about health does not in itself breach the disability provisions, but acting on the answers can.

Answer accurately, because the process exists to identify adjustments and safety needs rather than to screen people out. If you have a long-term condition, bring a list of medicines and any relevant letters. Section 60 itself is enforceable only by the Equality and Human Rights Commission, and an applicant can bring a tribunal claim if the employer’s conduct in reliance on health information contravenes the disability provisions.

NHS Employers describes the assessment being run by the employer’s occupational health service, with agency workers sometimes assessed by an accredited external provider. Other employers may use in-house or external providers in a similar way. Details of how your own assessment will be carried out should be set out in the conditional offer paperwork.