Bridging the Gap: How Onboarding Inefficiencies Worsen the ADHD Backlog

In the first part of this series, we examined the alarming backlog in ADHD assessment services – a crisis driven by surging demand and scarce resources. Equally important, however, is how effectively services can scale up to meet that demand. This second installment focuses on a less obvious but critical factor behind the backlog: inefficient staff onboarding processes.

When hiring and onboarding new clinicians is slow or cumbersome, clinics remain understaffed longer, throughput lags, and patients wait even more. Here we explore how outdated recruitment and compliance procedures are amplifying the ADHD care gap, and how streamlining these processes can improve assessment rates, patient safety, and staff satisfaction.

The Cost of Slow Hiring

Bringing a new doctor, nurse, or specialist into a service should be a swift but thorough process. In practice, NHS recruitment can be notoriously slow. Consider that it currently takes an average of about 10 weeks to recruit and onboard a new NHS employee. Much of this delay comes during the post-offer stage, where numerous pre-employment checks and paperwork must be completed. A case study from one NHS trust found that pre-employment checks alone often consumed over 32–35 working days – more than six weeks – before a new hire could start. Such drawn-out timelines mean that vital clinical positions sit vacant for months, even after a candidate has been selected.

Every extra week a position remains unfilled is a week in which patients on the ADHD waiting list see no improvement in service capacity. If a clinic has multiple vacancies or is trying to expand its team, slow hiring directly translates to fewer assessments conducted. For example, suppose an ADHD service secures funding for an additional specialist. If the hiring process drags on for three months, that’s three months in which the existing staff must shoulder the full load and patients see no benefit from the planned expansion. Multiply this across many roles and many clinics, and the impact on throughput is substantial. In essence, bureaucratic delay becomes a hidden bottleneck in the care pathway.

Inefficient onboarding also carries financial and human costs. Health service recruiters report that candidates frequently drop out during lengthy clearance processes, especially in today’s competitive job market. As NHS Employers noted, streamlining the journey from offer to start date is crucial because candidates will often abandon ship if another employer can get them started sooner. Private and third-sector providers face similar challenges – a talented ADHD nurse or psychiatrist might have multiple offers, and a slow onboarding process could mean losing them entirely. Every dropout forces the organisation to restart the recruitment, wasting valuable time and resources and prolonging the vacancy. It’s a vicious cycle: backlog leads to new hiring, slow onboarding leads to lost hires or delayed start, which in turn perpetuates the backlog.

Throughput, Patient Safety and Compliance Risks

For ADHD services, throughput, or assessment capacity,  is tightly linked to workforce size. When onboarding is inefficient, services operate below their potential staffing level for longer. This not only reduces the number of assessments that can be completed each month, but can also overburden the existing clinicians. Overworked teams have limited bandwidth to increase clinics or may experience burnout, further threatening service capacity. In contrast, if new hires come on board quickly, clinics can start extra assessment slots sooner, directly boosting throughput and easing wait times.

However, speeding up hiring should never come at the expense of patient safety and regulatory compliance. Each new clinician must undergo rigorous checks – professional registration verification, criminal record clearance, right-to-work documentation, references, and often mandatory training – to ensure they are qualified and safe to practice. The Care Quality Commission’s guidelines mandate that providers operate robust recruitment procedures and complete all relevant checks for staff. Failing to do so isn’t just a theoretical risk; it can result in unfit staff being employed and potential harm to patients, as well as serious legal or regulatory consequences for the organisation.

The problem with traditional onboarding is that these necessary checks are often handled through manual, fragmented processes – paper forms, emails back and forth, chasing external bodies for verification. That introduces delays at each step and opportunities for error. Important tasks might be done in sequence rather than in parallel, dragging out the timeline. For instance, waiting on a postal reference letter or a batch DBS check can add weeks. Any missing paperwork or miscommunication can reset the clock. Such inefficiencies force a trade-off: either start the staff member before full clearance (which is risky and generally not allowed), or keep patients waiting longer for care. Neither is a good option.

Streamlining onboarding can resolve this dilemma by reducing wait times for checks while maintaining thoroughness. Technology and better processes allow multiple vetting steps to proceed concurrently and alert managers instantly if something is pending. For example, digital systems can often verify professional licences (GMC, NMC registrations) in real-time online, rather than via postal correspondence. This means a clinician’s credentials are confirmed in days or hours instead of weeks. Similarly, electronic DBS services have faster turnaround than paper forms. By cutting out idle time in between steps, services can ensure new hires are fully vetted and “patient-ready” much sooner, upholding safety without prolonging the backlog.

Staff Morale and Onboarding Experience

It’s not only patients who suffer from onboarding inefficiencies – staff do as well. A clunky, prolonged onboarding process can frustrate new recruits at the very outset of their job. Imagine an enthusiastic new ADHD nurse who is eager to start making a difference, only to be stuck for two months submitting duplicate forms and waiting for updates. Research indicates that candidates who have a negative onboarding experience are far more likely to start looking for other opportunities shortly after. In other words, poor onboarding can sow the seeds of attrition even before Day 1 on the job. This is especially concerning in mental health services where retention is already challenging and every trained clinician is precious.

Moreover, slow onboarding often forces existing staff and managers to pick up extra work in the interim. Clinical team members may have to cover unfilled duties because the team is short-staffed. That adds to stress and burnout risk, further endangering retention. Meanwhile, HR personnel and team managers expend countless hours on admin: sending reminders for documents, manually checking registration databases, filing paperwork, and coordinating between departments. These administrative burdens can weigh heavily on morale and divert time from supporting staff development or improving services.

Streamlined onboarding processes can significantly improve staff satisfaction on multiple fronts. New hires benefit from a smoother, faster entry into their role – their first impression is that the organisation is efficient, which builds confidence. They can begin their clinical duties and integrate into the team without undue frustration. For current employees, faster onboarding means help is on the way sooner, reducing the period of understaffing and overwork. Managers and HR teams also enjoy a more manageable workload when automation handles repetitive tracking and chasing tasks. In short, everyone can spend more time on patient care and less on paperwork, contributing to a healthier workplace culture.

Streamlining Onboarding to Boost ADHD Services

Recognising these impacts, many healthcare providers are now seeking to modernise and streamline their onboarding. Simple improvements – like centralised digital tracking of a candidate’s clearance status, using e-forms instead of paper, and automating routine verifications – can make a big difference. NHS employers have noted that by tightening up recruitment steps and removing unnecessary delays, the time from job offer to start date can be slashed significantly, thereby reducing the chance of candidate drop-out and accelerating time-to-hire. Even introducing modest automation (for example, Robotic Process Automation bots to handle data entry or reminders) has yielded results; one NHS trust reported that deploying “hire bots” helped bring their average hiring timeline down from 55+ days to well under that, and dramatically cut the manual effort involved.

For ADHD services specifically, efficient onboarding means new clinicians (such as psychiatrists, nurse practitioners, psychologists and allied professionals) can start assessing patients sooner, directly helping to chip away at the backlog. It also ensures that quality and safety are maintained, as streamlined does not mean skipping steps – it means doing all the right steps faster and more reliably. The end result is a virtuous cycle: faster onboarding leads to more staffed clinics, which leads to shorter waits and better patient outcomes, which in turn improves staff morale as they are better able to deliver the care they trained for.

In our final part of this series, we will look at a cutting-edge solution to achieve these goals: digital onboarding and compliance platforms. In particular, we will introduce Credentially, a platform designed for healthcare hiring automation, and explore how its features – from automated licence checks to real-time dashboards and mobile-friendly workflows – are helping organisations dramatically improve time-to-hire and maintain regulatory readiness. By leveraging such tools, ADHD service providers can remove internal bottlenecks and truly start beating the backlog.

Sources:

• NHS England (2024). ADHD Taskforce announcement – rising demand and capacity challenges.england.nhs.uk
• BBC News (2024). Eight-year ADHD backlog at NHS clinics (analysis).bbc.com
• Berkshire Healthcare NHS FT (2023). Case Study – Reducing Time to Hire with RPA.ia.berkshirehealthcare.nhs.uk

Jobtrain (2023). How to stop losing NHS new hires at the clearances stage.hub.jobtrain.co.uk
Care Quality Commission (2014). Regulation 19: Fit and proper persons employed (Guidance).cqc.org.ukcqc.org.uk