Accessible Information Standard: A Practical Implementation Guide for GP Practices

The Accessible Information Standard (DCB1605) is a legal requirement for NHS providers. This practical guide shows GP practice teams how to implement the five-step framework, what communication needs to identify, and how to build evidence that satisfies CQC inspections.

Why the Accessible Information Standard matters

The standard is a legal requirement under the NHS Standard Contract and links to duties under the Equality Act 2010. CQC inspectors now expect systematic evidence of how practices identify, record, flag, share, and meet communication needs.

When the standard works well, patients with disabilities, sensory loss, or learning difficulties receive consistent support across appointments, referrals, and written communications. When it fails, patients miss vital information, promised adjustments disappear at referral points, and complaints escalate.

Integrated care systems rely on shared data to support patients across multiple providers. If your practice records communication needs but does not flag or share them, partners cannot continue the adjustments and patients experience gaps in care.

Understanding communication needs

Communication needs include any requirement for information in a different format or support during consultations. Common examples include:

Information format needs

• Large print letters, appointment reminders, and test results.
• Easy read documents with simplified language and supporting images.
• Braille or electronic formats such as audio files or accessible PDFs.
• British Sign Language video content or written materials in community languages.

Communication support needs

• British Sign Language interpreters for face to face appointments or video consultations.
• Language interpreters for patients whose first language is not English.
• Hearing loops, amplified telephones, or written communication for patients with hearing loss.
• Communication aids such as picture boards, symbol charts, or digital apps for patients with speech difficulties.
• Additional time, clear explanations, or step by step instructions for patients with learning disabilities or cognitive impairments.

Implementing the five-step framework

Step one: Identify

Ask every patient about their communication needs at multiple touchpoints. Do not rely on registration alone.

• Add AIS questions to new patient registration forms and annual health checks.
• Train reception staff to ask during appointment bookings and when patients mention difficulties.
• Encourage clinicians to identify needs during long term condition reviews, medication reviews, and safeguarding conversations.
• Use prompts on clinical screens to remind staff to check and update communication needs.

Frame questions in plain language. Ask: "Do you need information in a different format or support with communication during your appointment?" Offer examples so patients understand what adjustments are available.

Step two: Record

Document identified needs in the clinical system using standardised codes. This allows reporting, flagging, and sharing with other providers.

Use appropriate SNOMED CT codes or Read codes depending on your system. Examples include codes for hearing impairment, visual impairment, learning disability, or preferred communication method. Record specific details in free text, such as "prefers large print 16 point Arial" or "requires BSL interpreter for complex discussions".

Update records whenever needs change. A patient recovering from a stroke may need temporary communication support that should be reviewed after rehabilitation.

Step three: Flag

Make needs visible to every member of staff before each patient interaction.

• Configure alerts that appear when opening patient records, booking appointments, or generating letters.
• Add visual markers to appointment lists so reception staff prepare materials in advance.
• Include flags on repeat prescription slips, test result notifications, and referral summaries.
• Brief locum clinicians and visiting staff about flagged patients at the start of each session.

Test your flagging system regularly. Sample five flagged records each month and confirm the alert appears in every relevant workflow.

Step four: Share

Pass communication needs information to every service involved in the patient journey.

• Add AIS details to referral letters, discharge summaries, and care coordination notes.
• Notify hospital booking teams when patients need interpreters or accessible appointment letters.
• Share flags with community nurses, pharmacists, and physiotherapists who visit patients at home.
• Update integrated care record systems so all partners see current needs.

Check with patients whether they consent to sharing this information. Most patients will agree because it improves their care, but respect preferences and document decisions.

Step five: Meet

Provide the agreed format or support at every interaction.

• Arrange interpreters in advance with enough notice for booking and briefing.
• Produce letters and leaflets in the requested format before appointments.
• Allow extra consultation time for patients who need slower explanations or communication aids.
• Confirm with patients that the adjustment worked and ask whether changes are needed.

Track whether needs are met consistently. If a patient with a large print flag receives a standard appointment letter, investigate why the system failed and fix the gap.

Assigning roles and responsibilities

AIS lead

Appoint a named lead to coordinate implementation, review metrics, and escalate issues. This role typically sits with the practice manager or governance lead.

The AIS lead should:

• Monitor compliance with the five-step framework through quarterly audits.
• Review flagged patient lists to ensure adjustments are current and effective.
• Coordinate training for new starters, locums, and contractors.
• Liaise with PCN colleagues to align approaches across federated services.
• Report AIS performance to partners and quality meetings.

Reception and administrative staff

Reception teams are the first point of contact for identifying and recording needs. Train them to ask questions confidently, record details accurately, and arrange support before appointments.

Administrative staff who generate letters, results, and appointment reminders must check flags and produce accessible formats without delay.

Clinical staff

Clinicians identify needs during consultations, particularly when patients have difficulty understanding treatment plans or following instructions. They should update records, confirm adjustments are working, and involve families or carers when appropriate and with consent.

IT and system administrators

Technical staff configure alerts, reporting tools, and integration with shared care records. They test flagging systems, troubleshoot failures, and suggest improvements based on user feedback.

Building your evidence pack

CQC inspectors expect tangible proof that the standard is embedded across the practice. Prepare a folder with:

• AIS policy covering all five steps and linked to your equality and diversity policy.
• Staff training records showing induction sessions, refresher training, and competency checks.
• Audit results demonstrating identification rates, flagging accuracy, and whether needs are met.
• Sample patient records with clear documentation of needs and adjustments provided.
• Contracts or agreements with interpreting services, translation providers, and accessible format suppliers.
• Patient feedback showing satisfaction with communication support and suggestions for improvement.
• Action logs recording where the system failed, what was fixed, and how you prevented recurrence.

Store evidence in a shared folder that all leads can access. Update it quarterly and use it to brief new partners, prepare for inspections, and identify training needs.

Tracking metrics that matter

Monitor performance using simple indicators that show whether the standard is working:

• Percentage of patients with recorded communication needs compared to national and local prevalence estimates.
• Proportion of flagged records where alerts appear correctly in appointment lists, letters, and referral summaries.
• Number of patients receiving requested formats within agreed timescales.
• Complaints or incidents related to communication failures and whether numbers are reducing.
• Staff confidence scores from training evaluations and feedback sessions.

Review metrics at monthly governance meetings and share trends with the Patient Participation Group. Use the data to prioritise improvements and demonstrate progress.

Common pitfalls and how to avoid them

Relying on registration alone

Many practices ask about communication needs at registration but never revisit the question. Needs change after strokes, falls, mental health crises, or progressive conditions. Build multiple opportunities to identify and update needs throughout the patient journey.

Recording in free text without codes

Free text notes are invisible to reporting tools and do not trigger alerts. Train staff to use standardised codes alongside descriptive notes so systems can flag records and generate lists.

Flags that disappear

Some systems require manual refreshing of alerts or flags do not transfer across modules. Test your flagging workflow end to end and involve IT support when flags fail.

Forgetting to share with external providers

A patient with communication needs receives excellent support at your practice but arrives at the hospital without an interpreter because the referral omitted the flag. Include AIS details in every external communication and confirm receipt with receiving teams.

Arranging support too late

Booking an interpreter the day before a complex appointment rarely works. Build lead times into your process and confirm arrangements early.

No feedback loop

If patients never tell you whether adjustments worked, you cannot improve. Ask directly during reviews or via patient surveys and log responses.

Connecting with the Equality Act

The Accessible Information Standard works alongside reasonable adjustments duties under the Equality Act 2010. While AIS focuses on communication and information needs, reasonable adjustments cover broader changes to premises, policies, and practices.

A patient with mobility difficulties may need accessible parking and a ground floor consulting room (reasonable adjustments) as well as large print letters (AIS). Use a single reasonable adjustments log to track both types of need and avoid duplication. Consider linking AIS and equality processes so staff think about access holistically.

Learning from patient feedback

Invite patients with communication needs to share their experiences through surveys, PPG meetings, or one to one conversations. Ask specific questions:

• Did you receive information in your preferred format?
• Was the interpreter or communication support arranged on time?
• Did staff understand your needs and provide extra time or explanation when needed?
• What would make the process easier next time?

Use feedback to refine scripts, improve training, and celebrate success stories. Share learning with the wider team so everyone sees the impact of getting it right.

Preparing for CQC inspection

Inspectors will look for evidence that the Accessible Information Standard is embedded, not just documented. They may:

• Ask reception staff to explain how they identify and record communication needs.
• Review patient records to confirm needs are coded, flagged, and documented.
• Check whether appointment letters and test results appear in accessible formats.
• Interview patients with communication needs to hear their experience directly.
• Look at audit results, action plans, and whether improvements are sustained.

Prepare by running a self assessment using CQC quality statements. Focus on Responsive.4 (services meet individual needs) and Caring.1 (treating people with kindness, dignity, and respect). Test your systems, review training records, and fix gaps before inspection day.

Taking the next step

Start with a baseline audit this week. Sample ten patients with recorded communication needs and confirm each step is complete: identified, recorded, flagged, shared, and met. Use the findings to identify quick wins and decide where premium implementation packs, audit templates, and staff training modules will save time and reduce risk across your practice or PCN.

Disclaimer

This guidance is for general information. It is not a substitute for legal, clinical, or specialist advice. Always seek professional support tailored to your practice.