CES

Clinical Enabling Support (CES): Definition and Purpose (Updated 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-=6 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.