This article relates to the CQC key question: Is your practice responsive to people's needs?
The Equality Act 2010 replaced the Disability Discrimination Acts 1995 and 2005. It places a duty on employers and service providers to make reasonable adjustments for disabled people to ensure they are not disadvantaged compared with non-disabled people.
When does the reasonable adjustment duty apply?
This arises in situations which place a disabled person at a substantial disadvantage compared with people who are not disabled. These are where:
- A provision, criterion or practice is applied by or on behalf of the employer,
- A physical feature of premises occupied by an employer and service provider, or
- There is a lack of equipment provided (ie insufficient auxiliary aids or services – such as a reader, sign language interpreter or support worker)
In such cases an employer or service provider has to take such steps as is reasonable to take in all the circumstances to avoid that disadvantage; they have to make a ‘reasonable adjustment’ for their staff or people using their service.
As a health service provider, GPs have a duty to make reasonable adjustments for disabled people. Physical and mental conditions which might be treated as a disability under the Equality Act depending on the effect they have on an individual’s daily life are, for example:
- Problems with sight or hearing
- Conditions where the effects vary over time or come in episodes, such as osteoarthritis, rheumatoid arthritis, fibromyalgia, Myalgic encephalomyelitis (ME).
- Progressive conditions such as motor neurone disease, muscular dystrophy and forms of dementia
- Conditions which affect certain organs such as heart disease, asthma, and strokes
- People with a learning disabilities
- Learning difficulties such as dyslexia and dyspraxia
- Autistic spectrum disorders
- Mental health conditions – for example, depression, schizophrenia, bipolar affective disorders, eating disorders, obsessive compulsive disorder
- Impairments due to injury to the body or brain.
Making reasonable adjustments can have a positive impact on the wider community and benefit other people. It is therefore good practice and adds value to the service for everyone.
What is meant by ‘reasonable’?
Adjustments can be:
- Physical changes to a building
- Providing extra services, or
- Changing a policy or procedure.
When deciding whether an adjustment is reasonable, GP practices can consider issues such as cost (larger organisations are generally expected to invest more), practicality, health and safety factors, practice size, and whether the adjustment will achieve the desired effect.
If making the reasonable adjustments for disabled people would lead to the service breaking a different legal obligation, they may not be required to do it.
Reasonable adjustments for:
People with a learning disability
In GP practices this includes an annual health check and an action plan to address issues in the health check. Practices may involve a learning disability nurse from the community learning disability team who are specifically trained in enabling people with learning disabilities to access health care. This is part of the enhanced service for people over 14 years of age with a learning disability, see care of people with a learning disability in GP practices.
Practices should provide longer appointments for people with a learning disability.
People with physical impairment
People can be disadvantaged by physical features in and around buildings. Reasonable adjustments include providing:
- Ramps and stairway lifts
- Wider doorways
- Automatic doors
- More lighting and clearer signs
- Disabled wide-door accessible toilets with low basins
- Communication support
- A hearing loop
People with sensory impairment
GP practices should make reasonable adjustments for those with sensory impairments (someone who is blind, visually or hearing impaired, or with communication needs) so they can access services to meet their individual needs. For example, when patients in the waiting room are called to their appointment should this be by calling out their name, displaying appointments on an electronic screen or escorting them to the treatment room?
Do not assume that all deaf patients can read and write English – sign language may be their first language, so sign language interpreters should be available where possible.
Reasonable adjustments to communication
NHS England has developed the accessible information standard (AIS). This tells organisations how they should ensure that disabled patients receive information in formats that they can understand and they receive appropriate support to help them to communicate.
Timeline for implementation
All organisations that provide NHS funded care or publicly funded adult social care must implement these stages by:
- 1 September 2015 – begin preparations to implement (AIS), including:
- assessing current systems and processes; and
- developing and commencing roll out of a local implementation plan.
- 1 April 2016 – identify and record information and communication needs with service users:
- at the first interaction or registration with their service
- as part of on-going routine interaction with the service by existing service users.
- 31 July 2016 – fully implement and conform to the AIS.
Requirements for GP practices
Practices will need to:
- Identify and record the information and communication support needs of their patients and service users (and their carers or parents) where these needs relate to or are caused by adisability, impairment or sensory loss. They will need to take steps to ensure that those needs are met.
- Implement AIS through changes to their IT and administrative systems to enable consistent identification and recording of disabled patients, service users (and their carers and parents) information and communication support needs, and any changes, so they record and respond to those needs.
- Provide personal correspondence (eg appointment letters) and patient information (eg leaflets) in alternative formats and communication support for appointments (eg British Sign Language (BSL) interpreters). Alternative formats include braille and ‘easy read’ documents or email.
AIS does not cover language interpreting services, however NHS England have recently published a draft principles framework for high quality interpreting services in primary care. This covers both community language and BSL interpreting.
- Accessible Information Standard (AIS) – NHS England website
- Accessible Information Standard (AIS), detailed guidance and FAQs – BMA
- NHS England: draft principles for high quality interpreting and translation services
- Public Health England primary care services guide for making reasonable adjustments for people with learning disabilities
- Equality and Human Rights Commission - examples of reasonable adjustments
Kulvinder Hira is senior equality, diversity and human rights officer. at the CQC
More CQC resources
- View the full CQC Essentials series on Medeconomics
- CQC's recommended reading to help practices meet regulations and prepare for an inspection