The Bio-Audit
The one dependency nobody puts through diligence.
A forensic assessment of the biology behind executive capacity. Fourteen days of measurement, the full biomarker set, two hours in person, and a written read on whether your physiology is giving you room to operate or quietly working against you.
Dr Ben Ingram, MBBS BSc MRCGP. GMC 7040877. CQC registered. Kent, London and the South East.
The gap
You'd never buy a company without auditing the balance sheet. Nobody audits the person running it.
Diligence goes through the accounts, the contracts and the pipeline. It never goes near the physiology of the person the whole thing depends on, and that person is usually a man in his fifties who feels fine.
Almost nothing that takes a leader out of a business arrives as a surprise. It builds quietly, a little more each year, until it crosses a line. The window to act on it is long, and it is silent, and it closes without announcing itself.
Research published by Scottish Widows in 2026 found that 23% of UK small and medium-sized businesses would have to cease trading within a month of losing a key person, and 10% immediately if the owner were incapacitated. Legal & General put it at 26% closing straight away. Most of those firms hold key-person cover, which pays out after the event. Very few have ever measured the risk it insures.
This assessment measures it. It does not prevent anything, and nothing on this page claims it does. What it does is tell you where you actually stand, in numbers, while there is still room to change the direction.
What gets measured
Four systems, and the markers under each.
Every item earns its place by one test. If the result would not change what we do next, I do not order it.
01
Metabolic capacity
Energy stability under cognitive load. The system that decides whether your afternoon holds.
02
Cardiovascular reserve
Work capacity, recovery, and the state of the arteries carrying blood to your brain.
03
Endocrine regulation
The stress axis, thyroid and sex hormones. What sustained load has already cost.
04
Recovery and cognition
Sleep architecture, autonomic recovery, inflammation, and measured cognitive performance.
The measured set
ApoB · Lp(a) · fasting insulin · HOMA-IR · HbA1c · hs-CRP · homocysteine · full lipid panel
TSH / fT4 / fT3 · total and free testosterone with SHBG · AM cortisol with diurnal slope
omega-3 index · ferritin and iron studies · full blood count · liver and kidney function
VO2 max, measured directly · 12-lead ECG · blood pressure on both arms · 24-hour ambulatory blood pressure
carotid intima-media thickness and plaque · visceral adipose tissue · hepatic steatosis · muscle thickness and echogenicity
grip strength · gait speed · sit-to-stand · balance · waist-to-height
14 nights of sleep architecture, nocturnal heart rate variability and resting heart rate
14 days of continuous glucose monitoring · cognitive battery across attention, working memory and executive function
Why these, and not others
Most of that list does not appear on a standard health assessment at any price. Fasting insulin moves years before glucose does, and almost nobody measures it. ApoB counts the particles that actually do the damage, rather than the cholesterol they carry. Lp(a) is inherited, needs measuring exactly once in your life, costs a few pounds, and is missing from nearly every private health check in the country. The person most likely to be caught out by it is the one who looks after himself, has a normal cholesterol and gets told every year that everything is fine.
What I leave off matters as much. There is no full-body MRI here, no microbiome panel and no epigenetic age clock. Not because they are exotic, but because none of them would change what I do next. A test that cannot change the plan isn't medicine, it's decoration, and you're paying me to know the difference.
The list is short on purpose, and it is not fixed. What we need is a signal clear enough to be real, a safe and reversible change, and a direct way to verify the impact. When the evidence moves, the list moves, and so does your plan.
Confidentiality
The company can pay. The report is yours.
I report to you and to nobody else. No result, no finding, no summary and no record of attendance reaches the firm at any point, whoever settles the invoice. That is not a policy I can be asked to vary.
What the company gets is the knowledge that it happened. What you get is your own doctor, your own numbers and your own plan. If you later want something shared with anyone, you decide that, in writing, and you decide exactly what.
This is the first question every board asks and it is worth answering before it is put. A governance report on an individual's health creates problems under employment law, equality law and the duty of confidentiality I hold as a doctor. Removing it removes all three, and the assessment is better for it, because the person in front of me has no reason to hold anything back.
How it runs
Three contacts, and almost none of it costs you a day.
The Brief, 45 minutes
We meet. I take the context of the role and what it is asking of you, run a short structured screen, and measure one marker in the room. You leave with a written recommendation on whether the full assessment is worth your time, and with the monitoring kit fitted.
Fourteen days, in the background
A sleep monitor and a continuous glucose sensor run through an ordinary working fortnight. No change to your routine, and nothing for you to do. This is the part that separates a measurement from a snapshot, and it costs you no time at all.
The assessment, two hours
At your office or your home, at a time that suits. Fasting bloods first, then the examination, the functional testing, the ultrasound and the cognitive battery. I bring everything. You do not go anywhere.
The report, and an hour to talk it through
A written report across the four systems, in plain English, saying where you stand, what to act on now, what to watch, and the markers that will show it is working. Then an hour on a call going through it properly, because a report nobody explains is a document rather than a decision.
One reading tells you where you sit against a population. Two tell you which way you are going, and that is the number that decides anything. Everything here is built so the second reading means something.
The cost
One price, and no markup on anything.
The Bio-Audit is £5,000, all in. That covers the fourteen-day monitoring window and the kit, the full panel, the assessment day, the report and the hour that explains it. The sleep monitor is yours to keep.
Where a company arranges and settles the invoice, it is £4,500 per director, at any number of directors from one upward. One invoice, one conversation, and where there is more than one of you I run them across a single day at your offices. Most of the firms I work with have two or three people at the top. Some have one. The price per person is the same either way.
Company-arranged assessments also include a six-month re-read of the markers that moved, for each director, because a number that has changed is worth more than a number that has been filed.
Beyond the fee, nothing carries a markup. If your history or examination turns up something that needs a test outside the set, I tell you what it is, why it matters and what it costs before anything is booked, and it passes to you at exactly what it costs me. I earn the same whether I investigate you or reassure you, which is the point.
On the tax position. UK employers have a statutory exemption covering one health screening assessment and one medical check-up per employee per tax year, and since 2009 it has carried no requirement that the benefit be offered to every employee and no upper limit on cost. Directors-only provision sits inside it. I am a doctor and not your accountant, so confirm how it applies to your company before you rely on it.
For a leadership team wanting the assessment and a year of continuity behind it afterwards, there is a Board Programme. It is priced in conversation rather than on a page, because no two boards want the same thing.
Where to start
Start with the Brief.
Forty-five minutes, £450, in person. A structured screen, one marker measured in the room, and a written recommendation either way.
If the answer is that a full assessment would not tell you anything useful, I will say so and you will have spent forty-five minutes and £450 finding out, which is a better outcome than spending £5,000 to be told the same thing. The Brief carries no credit against anything and buys nothing except a straight answer.
Questions
The ones people actually ask.
Is this a health check?
No. A health check asks whether you are ill against population thresholds. This asks whether your biology is sufficient for the load your role is putting on it, and which way it is moving. Different question, different measurements, different report.
My company pays. What does it see?
That it happened, and nothing else. No results, no findings, no summary, no attendance record. That holds whoever writes the cheque and it is not negotiable.
How much of my time does it take?
Forty-five minutes for the Brief, two hours for the assessment, and an hour for the report. The fourteen-day measurement window runs through an ordinary working fortnight and takes none of your time at all.
Do I have to go anywhere?
No. I come to your office or your home with everything, including the bloods. There is no clinic and no waiting room.
What if something turns up?
I am a GP, so I manage it or I refer you to the right specialist first time, privately or on the NHS as makes sense. Referrals are part of what I do rather than something I charge for, and any investigation passes to you at cost.
What happens after the report?
For most people, nothing further is needed for a year. If you want the moving markers tracked through the year with a doctor watching them rather than filing them, that is the membership, and we can talk about it after you have the report rather than before.
Is this the same as your Assessment?
No. The Assessment is a half day and a written ten-year plan, built for households. The Bio-Audit adds a fortnight of continuous measurement, the deeper panel, the ultrasound and a cognitive battery, and it is written for someone whose job is making decisions.
Is it confidential from my NHS GP too?
Yes, unless you ask me to write to them. Many people do, because a result their GP does not know about is a result nobody acts on between now and next year. It is your call either way.