The aim of this study was to explore how small-scale enterprises (SSEs) utilize occupational health services (OHS) and how the possibility of OHS providers to support occupational health and safety management (OHSM) has developed over a 10-year period. Qualitative interviews were carried out with four OHS providers and their SSE clients, with follow-up interviews being conducted with three of the four OHS providers and their clients after 10 years. The decade saw a change in market conditions for the OHS providers with each becoming larger and developing more effective marketing tools. Despite these changes, the OHS providers had not developed more collaborative or closer relationships with their small enterprise clients. Rather than increasing, the utilization of OHS had declined, with health examinations remaining the most purchased service. In addition, the three OHS providers had not improved their support for OHSM in small enterprises during the decade.