Reasonable Adjustment Flag in NCRS

The Reasonable Adjustment Flag was developed to enable health and care professionals to record, share and view details of reasonable adjustments across the NHS. This is so that health and care professionals can understand individual needs and perform the associated adjustments required for a patient.

Health and care staff do not need to get explicit consent to create a shared reasonable adjustments record.

These are the role-based access control (RBAC) codes for the Reasonable Adjustment Flag in NCRS:

• B0264 can see that a Reasonable Adjustment Flag exists
• B0257 can view the details of a Reasonable Adjustment Flag
• B0380 can view, create, edit or delete a Reasonable Adjustment Flag

A Reasonable Adjustment Flag should only be created for patients who are identified as disabled under the Equality Act 2010 (opens in new tab).

When you create a Reasonable Adjustment Flag for a patient, you confirm that the patient has a condition with 'substantial' and 'long-term' adverse effects on normal daily activities.

The SNOMED code 1326341000000105, ‘Impairment with substantial and long-term adverse effect on normal day to day activity (Equality Act 2010)', is automatically added to the patient’s record when you create a Reasonable Adjustment Flag.

Only roles with RBAC codes B0257 and B0380 can view the details of a Reasonable Adjustment Flag.

The Reasonable Adjustment Flag can be seen in the ‘Overview’ and ‘Patient’ tabs.

If a Reasonable Adjustment Flag has been added for the patient, there will be an orange banner on the ‘Overview’ tab. You can click on this banner to view the Reasonable Adjustments flag.

The Reasonable Adjustment flag will contain:

• reasonable adjustments to consider
• underlying conditions
• Equality Act impairments to consider when making adjustments
• details of the user who created the Reasonable Adjustment Flag
• details of the user who last updated the Reasonable Adjustment Flag

Some of these sections might be empty because they are optional when creating the flag.

The reasonable adjustments content has not been optimised for printing.

Only roles with RBAC code B0380 can create a Reasonable Adjustment Flag.

1. When you open a patient record in NCRS, you will be taken to the ‘Overview’ tab. If a patient already has a Reasonable Adjustment Flag, it will be highlighted in a banner on this tab.
2. To create a Reasonable Adjustment Flag, go to the ‘Patient’ tab and click on 'Create a Reasonable Adjustment Flag'. You will not be able to create a Reasonable Adjustment Flag if the patient already has one.
3. Follow the steps to create the Reasonable Adjustment Flag. All sections that you can complete are optional, so it is possible to create a Reasonable Adjustment Flag and then update it with more information later.

Adding a patient's impairments to the flag

When you create a Reasonable Adjustment Flag, you can select the patient's impairments and add supporting text.

Adding Reasonable Adjustments to the flag

Add reasonable adjustments from a list based on SNOMED codes and adding optional supporting comments.

You can search for reasonable adjustments by either:

• browsing through a list of categorised SNOMED codes
• typing in the search box

There is a ‘Bespoke Reasonable Adjustments’ category if none of the adjustments on the list are suitable.

There is no limit to the number of reasonable adjustments you can add but the flag should only contain adjustments that are important for other health and care professionals to know at reception, on referral or in preparation for or on meeting the patient.

The information in the Reasonable Adjustment Flag will be shown with the user that added it. If you have any questions or concerns about an adjustment, it is recommended that you contact the user who originally added it before making any changes.

It is not possible to edit adjustments or impairments once they have been added to a Reasonable Adjustment Flag. To make changes, you must delete the adjustment or impairment and add it again.

When viewing a Reasonable Adjustment Flag, you can add impairments and adjustments by clicking on the 'Add reasonable adjustment' or 'Add impairments' buttons.

You cannot add an impairment if the 'Patient would prefer not to say' option has been added previously.

It is also not possible to add 'Patient would prefer not to say' if an impairment has been added previously. You must delete the existing impairment before adding the new option.

It is not possible to add underlying conditions in NCRS.

Deleting content from a Reasonable Adjustment Flag

You can remove impairments or adjustments from a flag, or delete the entire flag. To do this, you should:

• click on the 'Delete' link immediately below an impairment or adjustment to delete that part of the flag
• click on the 'Delete this reasonable adjustment record' button to delete the entire flag

You will have to select a reason for deleting the data and add supporting comments.

You will not be able to undo these actions so deleting data should be done with caution. It is not expected that this will be common practice. 

If you delete information that has been added by another user, that user will not be notified but Spine audits this activity.

It is not possible to delete underlying conditions in NCRS.