PeteTyerman at 12:24, 19 September 2025

2025-09-19T12:24:18Z

← Older revision		Revision as of 12:24, 19 September 2025
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	Plan was on the basis of ADHD/dyslexia adjustments we could be modified for any neurodevelopmental difference		Plan was on the basis of ADHD/dyslexia adjustments we could be modified for any neurodevelopmental difference

			However it makes it clear even without access to work support it is likely to be difficult to argue that the cost was unreasonable in the Equality Act terms

	== '''Clinical Enabling Support (CES) Models – Primary Care''' ==		== '''Clinical Enabling Support (CES) Models – Primary Care''' ==

PeteTyerman: CEL GP

2025-09-19T12:07:48Z

CEL GP

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CES business plan GP

Note: For a full explanation of Clinical Enabling Support (CES), including its definition, purpose, distinction from standard admin, and funding routes, see the accompanying document 'CES Definition and Purpose'.

Plan was on the basis of ADHD/dyslexia adjustments we could be modified for any neurodevelopmental difference

== '''Clinical Enabling Support (CES) Models – Primary Care''' ==

=== Salaried GP Adjustment Model: Clinical Enabling Support (CES) ===

==== 1. Current Baseline ====
- Average salaried GP earns ≈ £73k/year (~£40/hour).

- GPs spend ~30–40% of time on admin (referrals, prescriptions, correspondence, QOF).

- For ADHD clinicians, admin tasks take disproportionately longer, reducing patient time and increasing stress.

==== 2. Proposed Adjustment ====
- Band 5 CES (PA-level support).

- Salary ≈ £31k–37.8k/year (£16–19/hour).

- Allocation = 5 hrs/week CES (~0.15 FTE).

- Annual cost = ~£5,250.

- CES is in addition to and separate from practice reception/admin support.

==== 3. Break-Even (Without AtW) ====
- 5 hrs/week freed = ~250 hrs/year.

- GP time ≈ £40/hour → £10,000/year of value gained.

- CES cost = £5,250/year.

- Net gain: ~£4,750/year.

- Break-even = 2.6 hrs/week freed.

==== 4. With Access to Work Support ====
- Most GP practices have fewer than 50 staff by headcount.

- In these practices, AtW covers 100% of CES cost.

- Net cost to practice = £0.

- If more than 50 staff (rare, super-practices >30k patients), net cost ~£1,850/year.

==== 5. Equality Act Position ====
- ADHD = disability under Equality Act 2010.

- CES is additional to normal admin, reasonable, effective, and practicable.

==== 6. Secondary Outcomes ====
- ~250 hours of patient care year.

- Reduced burnout and sickness absence.

- Improved Targets and referral quality.

- Lower medico-legal risk.

==== Model Request Wording (Salaried GP) ====
“I am requesting approximately 5 hours per week of Band 5 Clinical Enabling Support (CES) as a reasonable adjustment for ADHD. This support would be in addition to and separate from the routine administrative support available in the practice.

My ADHD means I spend disproportionately longer on correspondence, referrals, and QOF documentation. CES would remove this barrier, freeing ~250 hours/year for patient care.

The cost of this adjustment is ~£5,250/year, which pays for itself if it frees just 2.6 hrs/week of my time. In most practices with fewer than 50 staff, Access to Work will cover 100% of this cost. In larger practices with more than 50 staff, the contribution would still be modest (~£1,850/year).

This adjustment is therefore both a legal requirement under the Equality Act and a practical way to improve patient access, reduce stress, and support GP workforce retention.”

== '''GP Trainee Adjustment Model: Clinical Enabling Support (CES)''' ==

==== 1. Current Baseline ====
- GP trainees earn ≈ £35–50k/year.

- Face both standard GP admin and training portfolio/ARCP admin.

- For ADHD clinicians, these tasks take disproportionately longer, risking delays or burnout.

==== 2. Proposed Adjustment ====
- Band 4 CES (junior PA-level support).

- Salary ≈ £26.5–30.1k/year (~£14–15/hour).

- Allocation = 5 hrs/week CES (~0.13 FTE).

- Annual cost = ~£3,750.

- CES is additional to and separate from normal practice admin support.

==== 3. Break-Even (Without AtW) ====
- 5 hrs/week freed = ~250 hrs/year.

- GP trainee time ≈ £20/hour → £5,000/year gained.

- CES cost = £3,750/year.

- Net gain: ~£1,250/year.

- Break-even = 3.8 hrs/week.

==== 4. With Access to Work Support ====
- Most GP training practices have fewer than 50 staff by headcount.

- In these practices, AtW covers 100% of CES cost.

- Net cost to practice = £0.

- If more than 50 staff, employer contribution = ~£1,550/year.

==== 5. Education & Training Tariff ====
- Training placements attract ~£12–13k per trainee annually.

- CES cost is a small fraction of this tariff.

- Framed as a legitimate training support cost.

==== 6. Equality Act Position ====
- ADHD is a disability under the Equality Act.

==== - CES is additional to normal admin, effective, reasonable, and practicable. ====

==== 7. Secondary Outcomes ====
- Higher training success rates.

- Reduced sickness absence and burnout.

- Improved retention into GP workforce.

- Lower remediation/extended training costs.

==== Model Request Wording (GP Trainee) ====
“I am requesting approximately 5 hours per week of Band 4 Clinical Enabling Support (CES) as a reasonable adjustment for ADHD. This support would be in addition to and separate from the routine admin support available in the practice.

My ADHD means I spend disproportionately longer on referrals, correspondence, and e-portfolio documentation. CES would remove this barrier, freeing ~250 hours/year for patient care and training.

The cost is ~£3,750/year, which pays for itself if it frees ~3.8 hrs/week. With Access to Work, in most training practices with fewer than 50 staff, the cost would be £0. In larger practices with more than 50 staff, the contribution would still be modest (~£1,550/year).

Since GP training placements are funded through the Education & Training tariff, CES is a proportionate use of existing funding. It is therefore both a reasonable adjustment under the Equality Act and a practical measure to ensure successful training outcomes.”

== '''GP Partner Adjustment Model: Clinical Enabling Support (CES)''' ==

==== 1. Current Baseline ====
- GP partners do not earn a fixed salary; income is from practice profits (average ~£100–120k/year).

- Partners carry additional business/admin duties (CQC compliance, HR, finance, rota planning).

- For ADHD clinicians, these tasks take disproportionately longer, risking burnout and reducing patient access.

==== 2. Proposed Adjustment ====
- Band 5 CES (PA-level support).

- Salary ≈ £31–37.8k/year (£16–19/hour).

- Allocation = 5 hrs/week CES (~0.15 FTE).

- Annual cost = ~£5,250.

- CES is additional to and separate from normal practice admin teams.

==== 3. Break-Even (Without AtW) ====
- 5 hrs/week freed = ~250 hrs/year.

- GP partner clinical time ≈ £40–60/hour → £10,000–15,000/year gained.

- CES cost = £5,250/year.

- Net gain: ~£4,750–9,750/year.

- Break-even = ~2–3 hrs/week.

==== 4. With Access to Work Support (Self-Employed Eligible) ====
- Self-employed partners are eligible for AtW.

- AtW can cover 100% of disability-related CES costs.

- Net cost to practice/partner = £0.

==== 5. Equality Act Position ====
- GP partners are covered as 'associates' under Equality Act 2010, s.53.

- CES is additional to normal admin, effective, reasonable, and practicable.

==== 6. Secondary Outcomes ====
- Improved retention and reduced burnout.

- Better governance and compliance.

- Enhanced patient access.

- Reduced locum/replacement costs.

==== Model Request Wording (GP Partner) ====
“I am requesting approximately 5 hours per week of Band 5 Clinical Enabling Support (CES) as a reasonable adjustment for ADHD. This support would be in addition to and separate from the routine administrative support available in the practice.

As a GP partner, my ADHD means I spend disproportionately longer on administrative and organisational tasks such as referrals, correspondence, rota planning, and compliance paperwork. CES would remove this barrier, freeing ~250 hours/year for direct patient care and safe practice management.

The cost is ~£5,250/year, which pays for itself if it frees just 2–3 hrs/week of my time. With Access to Work, CES support for self-employed partners can be funded in full, making the net cost to the practice £0.

This adjustment therefore represents both a legal duty under the Equality Act and a practical measure to support patient care, governance, and workforce sustainability.”

while the advice in this document is thought to be legally correct and has been checked so by AI it is not legal advice

CES BL BP - Revision history

PeteTyerman at 12:24, 19 September 2025

PeteTyerman: CEL GP