Accessing the Reasonable Adjustments feature in NCRS
Role-based access control
Role-based access control (RBAC) is a way of ensuring that users are appropriately authorised to access the data that they need to. RBAC is normally handled by an organisation’s registration authority. A registration authority is a function, usually within a NHS organisation, that carries out the identity checks of prospective smartcard users and assigns an appropriate access profile to the health professional's role as approved by the employing organisation.
Here's how it works:
- Users are assigned pre-defined roles - for example, Sarah is a general practitioner.
- Roles are linked to pre-defined activities - for example, general practitioners can view patients' demographic details.
- Users can have multiple roles - for example, Sarah might be both a general practitioner and a privacy officer.
- Roles can be linked to multiple activities - for example, a general practitioner might be able to both view and amend patients' demographic details.
In relation to the Reasonable Adjustments feature in NCRS, there are three levels of access each of which is governed by an RBAC activity code:
RBAC activity code |
What you can do |
What you can't do |
B0264 |
See whether a Reasonable Adjustment flag exists for a patient |
View the content of a Reasonable Adjustment flag
Create a new Reasonable Adjustment flag
Add content to an existing Reasonable Adjustment flag
Delete a Reasonable Adjustment flag
Delete content from a Reasonable Adjustment flag
|
B0257 |
See whether a Reasonable Adjustment flag exists for a patient
View the content of a Reasonable Adjustment flag
|
Create a new Reasonable Adjustment flag
Add content to an existing Reasonable Adjustment flag
Delete a Reasonable Adjustment flag
Delete content from a Reasonable Adjustment flag
|
B0380 |
See whether a Reasonable Adjustment flag exists for a patient
View the content of a Reasonable Adjustment flag
Add content to an existing Reasonable Adjustment flag
Delete a Reasonable Adjustment flag
Delete content from a Reasonable Adjustment flag
|
|
All user activity associated with the Reasonable Adjustments feature, including creating, viewing, updating, and removing a Reasonable Adjustment flag, is audited by Spine.
Creating a Reasonable Adjustment flag
When you open a patient record in NCRS, the 'Overview' tab will be displayed. Note, you cannot create a Reasonable Adjustment flag for a patient if one already exists.
To create a Reasonable Adjustment flag, navigate to the 'Reasonable Adjustment Flag' section of the 'Patient' tab and click on 'Create a Reasonable Adjustment Flag'.
Click on 'Start now' on the 'Create a Reasonable Adjustment Flag' page.
It is mandatory to record how consent for creating a Reasonable Adjustment flag was obtained: All the other sections of the flag are optional. It is therefore possible to create a flag containing only consent which can then be updated with impairments and adjustments at a later date.
Eligibility
Only create a Reasonable Adjustment flag for patients who are identified as disabled under the Equality Act 2010. For further information see the definition of disability as specified by the Equality Act 2010.
When you create a Reasonable Adjustment flag for a patient, you confirm that the patient has an impairment with 'substantial' and 'long-term' adverse effects on normal day to day activities.
The following SNOMED code is automatically added as part of the Reasonable Adjustment flag you create: 'Impairment with substantial and long term adverse effect on normal day to day activity (Equality Act 2010)' (1326341000000105).
Recording consent
Obtaining and managing consent for creating and updating the flag should follow existing national guidance and local processes for recording consent. For further guidance see:
It is mandatory to record how consent for creating a Reasonable Adjustment flag was obtained. There are four available options in addition to a text input field for adding further supporting comments:
- The patient provides consent.
- A best interest decision is made on behalf of the patient.
- A person with Lasting power of Attorney or Court Appointed deputy provides consent.
- Another legitimate patient representative provides consent. For example, someone with parental responsibility.
Best interest decisions
If adjustments in care would benefit the patient, clinicians can follow existing best interests processes to create a Reasonable Adjustment flag for patients who are not able to provide consent.
Click 'Next' to proceed to the next step.
Recording impairments
A person is defined as being disabled under the Equality Act 2010 if:
- they have a physical or mental impairment and
- the impairment has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities
For an impairment to have a substantial effect, it must have more than a minor or trivial effect on someone's ability to do everyday tasks such as preparing food, having a conversation, getting washed, walking or using transport. For further information, see the definition of disability as specified by the Equality Act (2010).
The purpose of recording and sharing patient impairments as part of a Reasonable Adjustment flag is to help other health and care professionals to understand individual needs and perform the associated adjustments required for a patient. You can select more than one impairment if appropriate and relevant and supporting text can be added for each selected impairment.
This is not intended to be a comprehensive list of a patient’s conditions. This information is classified as sensitive personal data and should only be recorded where relevant and necessary.
Patients not wishing to share details of their impairments
For patients who would prefer not to have their impairments recorded as part of the Reasonable Adjustment flag, select 'Patient would prefer not to say'.
Click 'Next' to proceed to the next step.
Recording adjustments
Reasonable Adjustments are recorded by selecting from a pre-defined list of SNOMED codes and adding any necessary supporting comments.
Select a Reasonable Adjustment by browsing through a list of categorised SNOMED codes:
Alternatively, search for an item by typing in the search box. Results matching your search term will appear as soon as you start typing. This search function will recognise common abbreviations and acronyms (for example, 'BSL' for 'British Sign Language').
Supporting comments can be added (up to 5000 characters) in the text input field which appears when a Reasonable Adjustment is selected.
You can record as many Reasonable Adjustments as necessary. However, the Reasonable Adjustment flag is not intended to be a comprehensive repository of all adjustments relevant to a patient. Many Reasonable Adjustments will be recorded and shared as part of detailed care plans or in care passports. Therefore, only key adjustments should be recorded on the Reasonable Adjustment flag.
To avoid the flag being overloaded, information should only be recorded where relevant and necessary. The focus should be on what is important for other health and care professionals to know at reception, on referral or in preparation for or on meeting the patient. Any supporting comments should be brief, to the point and should avoid the use of acronyms or local terminology not likely to be understood by users at other organisations.
Review and save
The information you have recorded will be displayed for you to review before it is saved. You can return to any of the previous steps to make amendments or to add additional information by clicking on the 'Edit' or 'Return to step…' links. You can remove an item by clicking on the 'Delete' link displayed immediately below it.
To save the Reasonable Adjustment flag, click on 'Save and complete'.
By doing this, you confirm that the patient has an impairment with 'substantial' and 'long-term' adverse effects on normal day to day activities.
The following SNOMED code is automatically added as part of the Reasonable Adjustment flag you create: Impairment with substantial and long term adverse effect on normal day to day activity (Equality Act 2010) (finding) | 1326341000000105.
See Creating a Reasonable Adjustment flag (Eligibility) for further information.
Viewing a Reasonable Adjustment flag
When you open a patient record in NCRS, the 'Overview' tab will be displayed. The presence of a Reasonable Adjustment flag will be indicated by a yellow banner containing the text 'Reasonable Adjustments present'. You can click on this banner to view the Reasonable Adjustments flag.
The Reasonable Adjustment flag will contain the following sections:
- Reasonable Adjustments to consider
- Underlying conditions
- Equality Act impairments to consider when making adjustments
- Consent
- Details of the user who created the Reasonable Adjustment flag
- Details of the user who last updated the Reasonable Adjustment flag
When creating a Reasonable Adjustment flag, it is only mandatory to record consent. Therefore, other sections of the flag (such as Equality Act impairments to consider when making adjustments) may not contain any data. In this case, the section heading in question will still be present but a line of text will inform you that no data has yet been added to that section.
The Reasonable Adjustments feature in NCRS has not been optimised for printing. It is therefore recommended that you do not attempt to print Reasonable Adjustment flags from NCRS.
Amending a Reasonable Adjustment flag
Each data item forming part of the Reasonable Adjustment flag will be displayed along with details of the user who recorded it. If you have any questions or concerns about a particular data item, it is recommended that you contact the user who originally recorded it before making any amendments.
It is not possible to edit or update individual adjustments or impairments once they have been added to a Reasonable Adjustment flag. To make changes, it is necessary to delete the adjustment or impairment (see Removing content) and record it again. It is not possible to add or remove underlying conditions via NCRS.
Adding content
When viewing a Reasonable Adjustment flag, additional impairments and adjustments can be added by clicking on either the 'Add Reasonable Adjustment' or 'Add impairments' button. These buttons will take you to the relevant screen where you will be able to add data items in addition to those already recorded. It is not possible to amend or remove existing data items on those screens.
It is not possible to add an impairment if the 'Patient would prefer not to say' option has previously been recorded - see Recording impairments (Patients not wishing to share details of their impairments). Likewise, it is not possible to record 'Patient would prefer not to say' if an impairment has previously been recorded. To do this, the existing impairment option must first be removed before the new option is recorded (see Removing content).
Removing content
When viewing a Reasonable Adjustment flag, it is possible to delete individual impairments or adjustments. It is also possible to delete the entire flag.
Click on the 'Delete' link immediately below an impairment or adjustment to delete that specific part of the flag. Click on the 'Delete this Reasonable Adjustment record' button to delete the entire flag and all its content. In both cases, you will be required to select a reason for deleting the data which must be supplemented by supporting comments.
Deleting data from a Reasonable Adjustment flag or deleting an entire flag are activities that should be undertaken with caution and it is not expected that this will be common practice.
If you delete information that has been recorded by another user, that user will not be notified. However, an audit of all such activity is maintained by Spine.
If you have any questions or concerns about a particular data item, it is recommended that you contact the user who originally recorded it before making any amendments.
Last edited: 31 January 2023 2:28 pm