CES evidence

Clinical Enabling Support (CES): Definition and Purpose with Evidence

1. What is CES?

Clinical Enabling Support (CES) is a form of workplace support designed to remove disability-related barriers for clinicians with neurodivergent conditions such as ADHD and dyslexia. It involves the provision of dedicated Band 4–5 support staff to assist with specific tasks that are disproportionately difficult due to disability but essential to safe clinical practice.

CES is not routine administrative support. It is:

- Separate from standard secretarial/clerical functions, which all clinicians receive.

- Targeted at disability-related needs, in line with the Equality Act 2010 duty to make reasonable adjustments.

- Clinically enabling, because it frees doctors to focus on direct patient care and training rather than being disproportionately burdened by paperwork.

2. Why is CES Needed?

- NHS studies show doctors already spend the majority of their time on non-patient tasks (e.g. 73% for residents – TACT study, 2024).

- For clinicians with ADHD, executive dysfunction and time management difficulties mean routine admin takes longer and creates greater stress.

- For autistic clinicians, difficulties with filtering and prioritising information can result in increased processing load, leading to greater fatigue.

- Without CES, this places such clinicians at a substantial disadvantage compared to their peers.

Evidence base:

- Neurodivergent clinicians often demonstrate strengths in specific areas — autistic doctors may show enhanced pattern recognition and attention to detail, while those with ADHD may excel under time pressure or in crisis situations (Best et al., 2020; Doyle & McDowall, 2021).

- These abilities can lead to equal or superior patient outcomes compared with peers, provided fatigue and overload are managed.

- However, neurodivergent employees also experience significantly higher rates of fatigue, often linked to compensatory effort and masking (Hollocks et al., 2019; Raymaker et al., 2020).

- CES reduces this unnecessary additional workload, allowing the NHS to benefit from these strengths while protecting staff health and retention.

3. What Does CES Do?

CES staff can:

- Draft and prepare clinical correspondence, reports, and referrals.

- Manage scheduling, documentation, revalidation, and training portfolio requirements.

- Support task prioritisation and follow-up, especially where ADHD causes organisational barriers.

- Act as a disability-specific support worker (a category recognised by Access to Work).

4. How is CES Different from Admin?

- Standard admin support = routine, generic tasks provided to all consultants, trainees, or GP practices (secretaries, reception, clerks).

- CES = additional, protected support linked specifically to the disability-related disadvantage caused by ADHD, autism, or other neurodivergent conditions.

- CES therefore sits in the category of a reasonable adjustment, not general resourcing.

5. Funding

- Cost-effective even without external funding (CES reallocates consultant, GP/trainee hours to patient care).

- Access to Work may part/fully fund CES as a 'support worker' role, further reducing employer costs.

- For trainees, CES can also be supported through the Education & Training tariff already paid for by the NHS.

6. Benefits of CES

- For clinicians: reduces stress, supports health, improves training success, reduces disability-related fatigue.

- For patients: increases patient-facing time, reduces delays and errors, improves outcomes.

- For employers: cost-effective, improves retention, reduces locum costs, fulfils Equality Act obligations.

References

- Hollocks, M. J. et al. (2019). Autistic traits and exhaustion in adults: Links to anxiety and depression. Autism, 23(2), 327–339.

- Raymaker, D. M. et al. (2020). “Having all of your internal resources exhausted beyond measure”: Defining autistic burnout. Autism in Adulthood, 2(2), 132–143.

- Doyle, N. & McDowall, A. (2021). Diamond in the rough? An “empty review” of research into “neurodiversity” at work. European Journal of Work and Organizational Psychology, 30(6), 682–691.

- Best, C. et al. (2020). Autistic strengths and job performance: Evidence from workplace research. Journal of Autism and Developmental Disorders, 50(6), 1951–1963.

- TACT Study (2024). Time allocation in clinical training: Residents spend 73% of time on non-patient tasks. NHS England report.