How to make your practice more accessible

The BMA give some simple tips on how to make your practice more accessible for your patients while ensuring you are compliant with the standard

The Accessible Information Standard is mandatory for all organisations that provide NHS or adult social care, including NHS trusts and GP practices. It ensures that people with a disability, or sensory loss, can access and understand information – eg., in large print or braille, or from a sign language interpreter.

What you are required to do

• Ask people if they have any information or communication needs, and find out how to meet their needs.
• Record those needs clearly, and in a set way.
• Highlight or flag this in the person’s file or notes so it is clear that they have information or communication needs.
• Share people’s information and communication needs with other providers of NHS and adult social care, when you have consent to do so.
• Ensure people are given information that they can access, and understand, and receive communication support if they need it.

Patients who the standard could apply to:

• Patients who have information or communication needs relating to a disability, impairment or sensory loss.
• Parents and carers of these patients, where appropriate.
• People with visual impairments, who have some hearing or visual loss.
• People who are deaf-blind.
• People with a learning disability. 

 Implementing the standard

• Think about how to identify individuals with information and communication needs when they contact the service (eg., at the reception desk, over the ‘phone) and when they register. Who will ask – when, and how? This is most likely to be the role of ‘first point of contact’ staff, such as receptionists.
• It can be helpful to agree on a ‘standard question’ which staff feel comfortable asking. 
• Brief staff about the standard, preferably in a face-to-face session, and follow up with email information about what it entails. Include, or point to, local policies and procedures for arranging the production of information in alternative formats and communication support.
• Inform patients about the Accessible Information Standard via posters and on-screen. Encourage patients to tell staff of their communication needs.
• The Accessible Information Standard does not include environmental, or facilities’ matters, but certain aspects are very relevant. Consider whether some rooms are ‘better’ than others for people with communication needs (eg., less cluttered, better light, more soundproof). Lighting can help or hinder a person trying to lip-read – aim for good light, but not blinding, and consider whether curtains or blinds can be drawn.
• Consider your workforce. What training have individuals and teams had on disability awareness and/or communication? Consider if any individuals are best placed to support people with particular needs, eg., a learning disability liaison nurse, or staff who have had specific training.
• Be aware some patients may have difficulty communicating with certain members of staff. People who lip-read often struggle to follow those with a beard or large moustache, for example.
• Can you easily access information in easy read and braille? Clarify the policy for arranging the conversion of documents and consider having the most commonly used documents converted ahead of any request.
• Can you access communication professionals, specifically a British sign language interpreter (BSL), speech-to-text reporter (STTR), deaf-blind manual interpreter or advocate? Clarify the process for booking such a professional. Is remote BSL interpretation or STTR possible?

Small steps you can take

To begin raising awareness with staff and patients or service users, some initial actions include:

• amending registration forms so they are more accessible and including a question or section about communication needs;
• adding a statement to letters and leaflets prompting patients to inform the service if they have communication needs;
• displaying posters and information in different formats, and encouraging patients to inform the service if they have communication needs;
• checking to see if there is an induction loop system available to support hearing aid users and, if so, checking that it works, and that staff know how to use it;
• engaging with your patient group to seek their support and advice. They may also have contacts in local voluntary groups with relevant expertise (eg., groups for the visually impaired; self-advocacy groups for people with learning disabilities)
• reviewing existing policy and practice around the use of email and text messages to communicate with patients; these can be quick, cheap and convenient ways of contacting many people with hearing or visual loss.

Other considerations

Recording patient needs

You can record communication and information needs using Read v2, CTV3 or SNOMED-CT codes, supported by free text. This information should be made available to patients where they choose to access their record online. In patients’ files, communication needs should be ‘highly visible’ so they are seen and acted upon. 

Your practice website

Your website is excluded from the standard; however, new regulations have come into force, which must have been complied with by 23 September 2020, which say that all public sector websites or apps must:

• meet accessibility standards;
• publish an accessibility statement.

Read this guidance from the W3 Web Accessibility Initiative on how to look for accessibility issues on your website. More information on how to comply with the regulations are available on GOV.UK.

Not complying

Non-compliant organisations are open to legal challenge and at risk of complaints, investigation and negative media coverage. Organisations are not required to report on their adherence to the standard, but they do need to publish, or display, an accessible communications policy which explains how they meet the standard, and an accessible complaints policy. This makes it easier for interested organisations to assess compliance, and enables patients and carers to give feedback about their experiences.

The CQC looks at evidence of implementation when judging whether services are responsive to people’s needs. Commissioners must help providers comply with the standard, including through contracts, tariffs, frameworks and performance-management arrangements.