Beyond the legal floor: raising the ceiling on neurodivergence in pharmacy

Pharmacy is a profession that often demands a fast pace, accuracy and constant, high-stakes decision-making over long hours. We are problem-solvers juggling clinical risk, supply crises and worried patients, often all at once. While this can be demanding — even exhausting — for anyone, many colleagues do it while navigating brains that process information, noise, time and social cues differently. If we continue to treat neurodivergence as an individual quirk, we will carry on losing compassion, vital contributions, capacity and talent, at a time when our NHS and the profession can least afford it.

Neurodivergent individuals do not lack knowledge, skill or intelligence; they simply interact with the world in ways that differ from what is considered typical. Pharmacy needs to move neuro-inclusive practice from ‘nice to have’ to non-negotiable. That means taking reasonable adjustments seriously, rethinking supervision and performance systems, and treating inclusion with the same seriousness as near-misses and error reporting.

Scale of the issue

Neurodivergence is more common than may be perceived, affecting around 15–20% of people in the UK. It includes people who have autism, attention deficit hyperactivity disorder (ADHD), dyslexia, dyspraxia and other conditions¹. The National Institute for Health and Care Excellence (NICE) estimates that around 1.1% of adults are autistic, likely an underestimate, with many reporting difficulties accessing diagnosis^2,3, and ADHD is estimated to affect 3–4% of UK adults⁴ — around 2.5 million people in England⁵.

These figures reflect us and our patients. In a profession that names inclusion as a priority, it is counterproductive not to see neurodivergence alongside age, gender, ethnicity and sexual orientation. In a workforce under pressure, designing work for how people function is a safety and productivity strategy, not a luxury.

Why the legal and regulatory baseline is not enough

Under the Equality Act 2010, employers must offer reasonable adjustments to disabled staff, whether or not they have a formal diagnosis⁶. Many neurodivergent people may not identify as disabled but the impact of their difficulties will often be recognised by law. In pharmacy, the General Pharmaceutical Council’s equality guidance, alongside the equality, diversity and inclusion strategy, set clear expectations for inclusive culture and the removal of barriers^7,8.

This is the floor, not the ceiling. In practice, adjustments often only appear after crisis, sickness or performance concerns. That reactive approach is stressful, risky and costly. A proactive model can reduce errors, improve retention and support sustainable services. A learning article in The Pharmaceutical Journal offers a practical starting point; the challenge is to apply it⁹.

Strengths we are missing

Neurodivergent colleagues bring strengths that, used well, are a genuine asset to pharmacy. Many offer sharp attention to detail, deep focus in the right conditions, systematic thinking that closes safety gaps, creative problem-solving, strong integrity around risk, reliable follow-through with clear expectations, pattern recognition and lived insight into accessibility.

Detail vigilance can catch subtle doses or prescribing errors before they reach patients. Systems thinking can turn a messy handover into a one-minute, structured summary that prevents missed actions. When time-protected, hyperfocus can deliver meticulous medicines reviews with clear benefits for patients. Creative problem-solving can turn a supply gap or system outage into a safe, stepwise pathway so care continues smoothly. We should not waste this.

Removing barriers

Most barriers concern the environment, not capability. Bright lights, alarms, overlapping voices and visual clutter can drain energy. Constant interruption breaks focus and increases error risk. Executive load, including time blindness (i.e. difficulty perceiving and managing time), makes starting, switching and stopping harder without clear expectations, simple ways to break work into blocks and short breathing spaces to reset. Unwritten rules and vague instructions cause confusion. Many colleagues mask to fit in, defined as suppressing or concealing neurodivergent traits, burning energy and leading to ‘crash’ days. Unpredictable rotas can undermine sleep and recovery.

When appraisals and supervision ignore these factors, context problems are misread as personal failings. Random, unstructured or last minute supervision adds stress instead of support. Culture matters, too: if people fear judgement, being seen as ‘less than’ or ‘getting special treatment’, or are told a diagnosis is required before support, they stay silent. The cost is high: more absence, presenteeism, higher turnover, time-consuming complaints and investigations, falling morale, rising burnout and fragile services.

A 2023 cross-sectional study of 225 autistic doctors reported very high rates of poor mental health, including suicidal ideation (77%), self-harm (49%) and suicide attempts (24%), with fewer than half of those requesting adjustments received these . This is a clear signal that environments and processes must change, not the individuals¹⁰.

What needs to be done?

Neurodivergence must be taken seriously. That means changing how we design work, how we behave and how we judge success.

1. Change the workplace (diagnosis not required)

Start with needs: offer and record work adjustments, review after 6–12 weeks, keep what works. Make this clear from recruitment  and induction, and name a confidential contact; support should not depend on a formal diagnosis. Protect focus with short no-interruption blocks and clear ‘on questions’ cover. Make expectations and time visible: say what needs doing and by when, and support people to use simple planning tools if helpful. Reduce sensory load where possible and signpost to schemes, such as Access to Work, if adaptations are needed. Use simple, consistent handovers, brief written follow-ups and small checklists. Keep supervision structured and predictable; look at the set-up before blaming the person. Stabilise rotas where you can, avoid late-finish/early-start patterns and protect time for supporting professional activities such as audit, quality improvement (QI) and reflection. Many of these suggestions mirror ACAS guidance; they are not radical, just underused. 

2. Shift the culture

Say clearly that support is not ‘special treatment’ but a route to equal opportunity. Model this from the top, equip managers, normalise tools and share small wins.

3. Aim for equality of outcome

Judge contributions not by numbers alone, but instead by safe care, reliability, insight, improvement work and teamwork; different brains, equally valued impact.

A call to the profession

Neuro-inclusion is not a bonus. It sits alongside patient safety, workforce wellbeing and QI. Much of what we need is already in policies; the gap is daily practice under pressure. We must design robust systems where neurodivergent colleagues do not fall through the cracks. As a profession that is used to risk assessment, standard operating procedures and continuous improvement, we are well placed to close that gap. We can keep treating neurodivergence as a quiet, individual problem or recognise it as essential infrastructure. When we get it right, work becomes safer, fairer and kinder for everyone. It is time to raise the ceiling.

If any of this sounds familiar, you are not alone. You are part of the beautiful diversity of humans and your contributions are valuable and valued, even if it does not feel that way. You do not need to break yourself to fit a system that was not designed with you in mind; you need the right conditions and support to do your best work. 

Where it feels safe, voice your needs and be clear about what helps. Employers have a responsibility to listen. If nothing changes after genuine attempts and you are continually pushed beyond what feels healthy or fair, it may be a sign to consider whether your talents and abilities may be better utilised or appreciated elsewhere.