Supporting Neurodivergent Practitioners: The Role of NHS Resolution’s Practitioner Performance Advice Service
Dr Rineke Schram (NHS Resolution) and Dr Elizabeth Stonell (NHS England Yorkshire and Humber)
A note on language
We have used the following language in line with other NHS publications and guidance available at the time of publication. We recognise the importance of describing neurodivergent people respectfully, making it clear that they are valued. We will continue to monitor any changes to language describing neurodivergent conditions.
We describe ‘autistic practitioners’ in line with guidance from NHS England, Making information and the words we use accessible. We describe other neurodiverse conditions as, for example, ‘practitioners with Attention-Deficit Hyperactivity Disorder (ADHD)’, in line with the NHS England taskforce work on ADHD.
Introduction
In today’s NHS, we are not only recognising but celebrating the extraordinary value that neurodivergent practitioners bring to healthcare. A GP with ADHD may channel energy and rapid problem-solving into thriving under pressure. An autistic surgeon may bring unparalleled depth of focus and precision to complex procedures. These are not just individual strengths, they are assets to patient care and to the teams they work within. Neurodivergent professionals enrich our workforce with fresh perspectives, exceptional skills, and a diversity of thinking that drives innovation and excellence across the NHS.
We also understand that different ways of thinking, communicating, or working can sometimes be misunderstood, creating tensions between colleagues or even leading to concerns about performance. NHS Resolution’s Practitioner Performance Advice service works with healthcare organisations to understand what may be driving these tensions and find constructive, supportive ways to manage them. This approach matters – not only because of the valuable skills these individuals bring, but also because they may make up a significant, but often under-recognised, part of our workforce.
Where diversity – across the whole workforce – is underpinned by inclusion, staff engagement, retention, innovation and productivity improve. Inclusive environments create psychological safety and release the benefits of diversity – for individuals and teams, and in turn efficient, productive and safe patient care.
This publication compiles key guidance on recognising neurodivergence within the healthcare workforce and outlines employer responsibilities. We recognise there are a range of contractual provisions in respect of practitioners including employment and contractual arrangements. For example, practitioners on Performers Lists are not employed by NHS England.
Drawing on insights from Practitioner Performance Advice with support from neurodiversity experts, it connects employers with reliable information and directs them to specialist resources. Our goal is to help employers recognise when neurodivergence may underlie performance concerns, understand how to address these issues appropriately, support practitioners, and maintain patient safety.
Practitioner Performance Advice have provided a framework to help employers to fairly, proportionately and consistently address performance concerns. This framework focusses on ensuring welfare and support, recognising neurodivergence and other health concerns as a possible contributing factor and ensuring decisions reflect both individual context and relevant policies.
Organisation responsibilities
Under the Equality Act 2010, organisations have a legal duty to make reasonable adjustments for individuals who are neurodivergent and meet the definition of having a disability/being disabled under the Act. An individual does not need a diagnosis to be considered disabled under the Equality Act 2010. Specialist health assessments may assist both practitioners and organisations in determining whether a neurodivergence equates to a disability.
This means that organisations must ensure that neurodivergent and disabled individuals (those who satisfy the definition of a disabled person under the Equality Act 2010) are not discriminated against due to their disability which includes being subjected to:
- less favourable treatment, compared to individuals who are not disabled;
- a disadvantage, compared to individual who are not disabled when the organisation puts in place a ‘provision, criterion or policy’ (a rule);
- unfavourable treatment because of something arising in consequence of their disability; or
- unwanted conduct.
This also means that organisations may need to make reasonable adjustments to mitigate any substantial disadvantages which the individual may face, when compared to individuals who are not disabled.
Reasonable adjustments can include coaching, flexible working arrangements, providing specialised equipment, modifying the work environment and offering regular check-ins and support. It is crucial for organisations to recognise signs of neurodivergence and proactively seek to accommodate these individuals. More information on legal obligations is provided here: Neurodivergence in the workplace: employment law considerations.
Coaching may warrant particular consideration given evidence that it can improve memory, time management, organisational skills, stress management and concentration for neurodivergent individuals. The role of reasonable adjustments is to help ensure a neurodivergent person can work at the same standard as their peers and does not mean there should be any reduction of standards in terms of quality, quantity and conduct.
Additionally, organisations must not subject neurodivergent and disabled individuals to a detriment because of something which the individual has done, or is believed to have done, what is called a ‘protected act’. A protected act includes:
- bringing internal or external proceedings relating to the Equality Act 2010;
- giving evidence or information in connection with the Equality Act 2010;
- doing any other thing for the purpose of or in connection with the Equality Act 2010; or
- making an allegation about someone having contravened the Equality Act 2010.
What is neurodivergence?
Neurodiversity refers to the breadth of human cognitive functioning, including both those whose cognition is typical and atypical. Neurodivergence is the term for when someone’s brain processes, learns, and/or behaves differently from what is considered “typical”. Neurodivergence can be classed as a disability under the Equality Act 2010, although some neurodivergent people do not identify as disabled but need support to live in a neurotypical society. An employee does not need a diagnosis to be considered disabled under the Equality Act 2010.
Although the prevalence of neurodivergence within the medical workforce is currently unknown, Dr Elizabeth Stonell, speaking from her experience supporting GP Registrars, suggests that as many as 29% of GP registrars in the Yorkshire and Humber Deanery identify as neurodivergent, highlighting the importance of recognising and supporting this significant part of our workforce.
We should acknowledge that there is an increasing societal awareness of neurodivergence. Receiving a diagnosis may be difficult, but it can bring about significant changes both personally and professionally. It also enables employers and colleagues to better understand the practitioner and discover new ways to collaborate effectively. In light of extensive waiting lists for assessments in the NHS and the high costs associated with private diagnoses, it is important to recognise that some individuals may have self-diagnosed. This necessitates a considerate and collaborative approach between employer and employee to identify effective methods of working together.
While common definitions of neurodivergence focus on specific conditions, the lived reality is far more nuanced. Everyone’s experience is shaped by a range of personal, cultural, and situational factors that can influence how their neurodivergence is expressed, perceived and supported in the workplace and these factors may also influence any barriers to disclosure. Understanding these factors is essential for creating an environment where all colleagues can thrive. Examples include:
- Cultural and demographic considerations – a substantial proportion of the NHS medical workforce is made up of international medical graduates (IMGs), some from countries where neurodiversity is not widely recognised. It is important for employers to recognise this and other obstacles, offering culturally sensitive support to help neurodivergent IMGs succeed. Please see Practitioner Performance Advice’s Support for practitioners page for signposting to relevant organisations and other resources at the end of this page. Factors such as gender identity and ethnicity should also be taken into account.
- Masking – this is the conscious or unconscious suppression or camouflaging of neurodivergent traits, behaviours or needs to fit into a neurotypical society. This can involve mimicking others’ social behaviours, suppressing natural expressions, or concealing sensory challenges. While masking can help individuals ‘fit in’, it is often exhausting and can take a significant emotional and physical toll.
- Rejection sensitivity dysphoria (RSD) – an intense emotional response to perceived rejection, criticism, or failure, often associated with neurodivergent conditions. Without constructive, supportive feedback, RSD can make professional growth more difficult.
- Acquired neurodiversity – refers to changes in a person’s brain functioning that occur due to injury or illness. This type of neurodivergence can lead to variations in cognition and behaviour, and it differs from congenital neurodivergence as it develops later in life. For example, conditions like Long Covid or brain injuries can result in acquired neurodivergence.
Why understanding neurodiversity matters in performance conversations
Performance conversations are most effective when they are informed by a genuine understanding of the individual. Without recognising a practitioner’s neurodivergence, or without putting the right support in place, challenges may arise and present as performance concerns. Understanding the underlying cause is key to addressing the concerns and also recognising areas of strength. For example:
- A practitioner with dyslexia may experience difficulties with documentation or written accuracy but excel in verbal communication, patient rapport and creative problem-solving.
- An autistic person might prefer clear, structured, written communication and find unpredictable team dynamics overwhelming, yet bring exceptional focus, precision and consistency to their clinical work.
- A doctor with ADHD may need strategies or tools to support time management, but can offer high energy, adaptability and innovative thinking under pressure.
When these differences are not recognised or accommodated, they can lead to avoidable stress, damaged working relationships, formal investigations, or even the loss of skilled practitioners from the profession.
It is also important to recognise that neurodivergent conditions may initially present as other concerns. For instance, mental health issues such as anxiety, depression or burnout can mask underlying neurodivergence or be the result of unsupported neurodivergence in a high-pressure environment. A recent study found that over one-third (35%) of doctors accessing NHS Practitioner Health for mental health support screened positive for ADHD, highlighting the importance of careful, informed exploration before drawing conclusions about performance.
Supporting neurodivergent practitioners extends beyond compliance or inclusion; it is essential for safeguarding wellbeing, retaining valuable talent, and fostering constructive discussions that promote development and strengthen team collaboration.
Neurodiversity case studies learning pack
The following case studies have been developed by Practitioner Performance Advice to promote learning, considerations, support and resolution options when performance concerns for practitioners who are neurodivergent, or who have a suspected diagnosis, arise.
This pack contains three case studies. They are based on the type of cases that Practitioner Performance Advice may be asked to advise on and draw on the examples of performance concerns experienced by practitioners who are neurodivergent. You may wish to consider the cases with peers or your decision-making group.
How the Practitioner Performance Advice service helps
Our Advisers have undertaken continuing professional development to strengthen their ability to support employers managing cases where neurodiversity may be a factor.
Be aware that managing complex cases involving neurodiversity and performance concerns can have an emotional impact on the managers providing support. Ensure you seek supervision or support for yourself as needed.
We can support through:
- Early, informal resolution – by encouraging proactive, open conversations at an early stage, Advice helps employers identify the underlying causes of concerns before they escalate – including where neurodivergence may be contributing. We support employers to build inclusive workplaces where everyone can thrive, rather than waiting until performance concerns reach a formal stage.
- Tailored guidance – our Advisers can suggest when to consider a neurodiversity assessment or signpost you to options for arranging one. We also advise on exploring workplace adjustments required by the Equality Act 2010 and when seeking legal opinion may be necessary.
- Compassionate conversations – we help leaders and managers approach discussions with curiosity, empathy, and a focus on solutions. This is particularly important for practitioners who may experience RSD, where perceived criticism can have a significant emotional impact.
- Behavioural assessments – while the occupational psychologists we work with do not undertake formal assessments to diagnose neurodivergent conditions, they can identify behavioural patterns for practitioners where there are concerns about conduct or behaviour in the workplace, which may be consistent with a neurodivergent profile. This provides valuable insight for planning next steps and suggestions about how they can be managed and accommodated in the workplace. We want to emphasise to those considering a referral for a behavioural assessment that this should be made only where there are concerns about conduct or behaviour in the workplace, rather than for the purpose of obtaining a neurodiversity diagnosis.
- Action plans – Practitioner Performance Advice can develop remedial action plans tailored to the needs of neurodivergent practitioners. These plans can focus on providing practical support in the context of appropriate workplace adjustments that enable individuals to manage more effectively in their roles.
- Signposting and ongoing support – we can signpost you to relevant services, including NHS Practitioner Health, which offers confidential mental health and wellbeing support for doctors and dentists, including those who are neurodivergent.
- Sometimes action is needed to protect patient safety – and not all cases can be managed through adjustments alone. If a practitioner’s neurodivergence poses a risk to patients, perhaps because they do not accept this or will not engage with safety measures, we can advise on what steps to take to protect patient safety, whilst supporting the practitioner.
Practitioner responsibilities
It is important to recognise that neurodivergent practitioners, like all healthcare professionals, have a responsibility to cooperate with their employer in upholding patient safety standards. This includes engaging openly in discussions about their needs, participating in agreed workplace adjustments, and communicating any challenges that might affect their ability to deliver safe care. By working collaboratively with their employer, neurodivergent practitioners help to ensure that appropriate support is in place, reducing risk and promoting positive outcomes for patients and teams alike.
By working in partnership with employers, Practitioner Performance Advice aim to create environments where practitioners are understood, supported, and enabled to contribute their best, benefiting both the individual and the wider NHS.
Other helpful resources
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