Reasonable adjustments in clinical and NHS roles
Ryan Hoare · Founder, TryMosaic · Last reviewed
This guide is part of our complete guide to reasonable adjustments by role.
The constraint is real. It is also the starting point
Clinical work carries constraints most roles do not: safe staffing levels, professional regulation, and services that cannot pause. Those constraints are real, and they are also where adjustment conversations go wrong, because a real constraint gets used as a full stop. The duty under the Equality Act 2010 applies to clinical employers as it does to everyone else; the constraint shapes which adjustments are reasonable, not whether the question gets asked.
Rotas and on-call
- Fixed or predictable shift patterns within the rota, where rotation aggravates a condition. Rota software makes this more feasible than it was a decade ago.
- Adjusted or reduced on-call commitments, offset across the team, where night disruption is the specific barrier.
- Phased returns with supernumerary periods after long absence, stepping back into clinical load on an agreed schedule.
The working day
- Protected time for documentation and admin, rather than notes written in stolen minutes, where concentration or fatigue is the barrier.
- Quieter working areas for non-patient-facing tasks, and permission to use them without renegotiation each time.
- Equipment: dictation tools for clinical notes, ergonomic instruments and seating, screen adjustments for clinical systems.
- Supervision and support arrangements: structured check-ins, a named senior contact, and clarity about what to do when overload hits mid-shift.
Working with occupational health
Clinical employers make heavy use of occupational health, which is a strength when the referral question is framed well. Ask what adjustments would enable this person to do this role safely, not whether the person is fit. And treat the OH report as the start of the management conversation: the recurring failure in healthcare is an OH recommendation that everyone agrees with and nobody implements, because rotas are hard and the ward is busy. An adjustment with an owner and a review date survives that pressure; a recommendation in a filed report does not.
Disclosure in clinical culture
Where a clinical culture treats needing adjustments as a competence question, people stop disclosing. The practical countermeasure is procedural: a clear, confidential route to request adjustments that does not run through the person who signs off your training progression, and visible evidence that people who asked were supported rather than quietly benched.
This guide is general guidance, not legal advice. For advice on your specific obligations, speak to an employment law specialist, your defence organisation or ACAS.
If you are evaluating vendors, book a short TryMosaic demo and put the questions above to us first.
References
- Reasonable adjustments at work (ACAS)
- Equality Act 2010, section 20: duty to make adjustments (legislation.gov.uk)
- NHS Employers (NHS Employers)
- Access to Work: get support if you have a disability or health condition (GOV.UK)
Related guidance
Frequently asked questions
Can NHS staff get reasonable adjustments despite safe staffing rules?
Yes. Safe staffing shapes which adjustments are practicable, but it does not remove the duty. Rota patterns, on-call arrangements, protected admin time, equipment and supervision structures all offer room to adjust within safe staffing levels.
Can on-call be adjusted as a reasonable adjustment?
It can, where on-call disruption is the barrier and the team can absorb the change. Reduced, adjusted or redistributed on-call is a recognised adjustment; refusing it needs a recorded reason specific to the service, not a general appeal to fairness.
What should an occupational health referral ask?
Frame it around enablement: what adjustments would allow this person to do this role safely and sustainably. Referrals framed as fitness verdicts produce binary answers, discourage disclosure, and miss the adjustments that would have solved the problem.
Why do agreed adjustments fail in hospitals?
Implementation, more than agreement. An OH recommendation everyone accepts still needs someone to change the rota, order the equipment and defend the protected time when the ward is short. Adjustments with a named owner and a review date survive operational pressure; filed recommendations do not.
Do adjustments follow staff who rotate between departments?
They should, and rotation is exactly where informal arrangements break. A recorded adjustment that moves with the employee, surfacing to each new supervisor with consent, prevents the pattern where every rotation restarts the disclosure conversation from zero.
Published · Last updated · This guide will next be reviewed by .
TryMosaic is the system of record for workplace adjustments under the Equality Act 2010.