Please note - this article is subject to change, as the Access Care Planning implementation of RADF is undergoing final NHS England review.
The final solution and information outlined in this article may update at any time.
The Reasonable Adjustment Digital Flag (RADF) is a national NHS record that indicates a client requires reasonable adjustments under the Equality Act 2010. It records:
Impairments — the disability or condition that requires an adjustment (e.g. learning disability, visual impairment, mental health condition).
Adjustments — the specific changes needed to make care accessible (e.g. longer appointment times, easy read information, BSL interpreter).
Underlying conditions — additional clinical context that supports the impairments recorded (e.g. Down syndrome, autism spectrum disorder)
Consent — whether the client has objected to their information being shared.
From September 2026, all NHS and publicly-funded health and social care providers are required to record, share, and act on reasonable adjustment information. ACP connects directly to the NHS NCRS so this information can be shared across care settings.
Training requirements
NHS England requires all staff who interact with reasonable adjustments to complete training before using this feature.
System use — this article is your training resource for how to access, record, and manage reasonable adjustments in ACP.
Clinical context — what reasonable adjustments are, why they are required under the Equality Act 2010, and how they apply in healthcare. See the NHS England Reasonable Adjustment Flag Service Catalogue for central resources.
Staff should revisit the NHS resources regularly as national guidance is updated periodically.
Before you start
You must have Reasonable Adjustments View or Reasonable Adjustments Edit permission assigned to your role. This is separate from general case access — contact your administrator if you cannot see the Reasonable Adjustments section.
The client must have an active case in ACP.
If the client's case is archived, the Reasonable Adjustments section is not available.
To submit or receive data from the NHS National Care Records Service (NCRS), your tenant must have an ODS code configured and RADF must be enabled in Tenant Preferences.
Tenant Admins: Tenant Admin access does not automatically grant visibility of RADF data. A Reasonable Adjustments permission role (Restricted View, View, or Edit) must be explicitly assigned to your account, in the same way as GP Connect.
Client demographic data required for NHS verification
Before activating the flag, the following fields must be complete and accurate on the client record: First Name, Last Name, Date of Birth, and Gender.
ACP validates client identity against the NHS Personal Demographics Service (PDS) on activation and rechecks every 24 hours. If any field is missing or incorrect, activation will fail or access to the page will be blocked.
⚠️ Gender values: Gender must be one of: Male, Female, Not Known, or Not Specified. Any other value — for example "Unknown" — will cause PDS validation to fail. Update the client record to restore access after a failed check.
Enable RADF in Tenant Preferences
Before any staff can use this feature, a Tenant Admin must enable RADF in Tenant Preferences.
Go to Tenant in the left sidebar, then select Preferences.
Find the Enable RADF preference and change it from No to Yes.
Select Save.
⚠️ ODS code required: Your tenant must have an ODS code configured before RADF can be enabled. If no ODS code is found, the save will be blocked. Go to Tenant → [your tenant name] → Edit to add your ODS code first.
⚠️ DSPT requirement: Your tenant must complete the NHS Data Security and Protection Toolkit (DSPT) before enabling RADF. ACP does not verify DSPT status — this is your tenant's responsibility. Do not enable RADF until DSPT completion is confirmed.
Find the Reasonable Adjustments section
Open a client's case file.
In the left-hand navigation, select Reasonable Adjustments.
The Summary tab opens by default, showing the client's current flag status, adjustments, and NCRS sync status.
If a client has reasonable adjustments recorded, an orange banner appears at the top of every page in the case file, visible to all staff who open the case.
Record reasonable adjustments
You need RADF Edit permission to add or change adjustment information.
Tip: If a supporting comment has been recorded on an adjustment, impairment, or underlying condition, the card will open automatically when the page loads so the comment is immediately visible. Cards with no comment remain collapsed. You can manually open and close any card at any time.
Activate the flag
Go to Reasonable Adjustments in the left-hand navigation.
Select Activate flag.
Confirm the action. The flag status changes to Active and the orange banner appears across the case file.
If no adjustments, impairments, or underlying conditions have been recorded yet, the page displays: "The Reasonable Adjustment Flag has been set, but no reasonable adjustments have been recorded for this patient. To obtain details of the Reasonable Adjustments, please consider speaking to the patient or their carer directly and/or reviewing their clinical record."
Add an impairment
On the Summary tab, select Add impairment.
Search by name or code, or scroll the list (e.g. Dexterity, Hearing, Memory, Mental health, Mobility).
Select the impairment from the list.
Optionally, add supporting comments (up to 5,000 characters).
Check Also record this on the patient's national record to share with the NHS national record.
Select + Add impairment.
You can record multiple impairments. If none apply, select Patient would prefer not to say.
Add an adjustment
On the Summary tab, select Add adjustment.
Search by name or code, or browse by category (e.g. Communication support, Requires specific information format).
Select the specific adjustment from the list.
Check Also record this on the patient's national record to share with the NHS national record.
Select + Add reasonable adjustment.
Add an underlying condition
On the Summary tab, select Add underlying condition.
Search by name or code, or browse by category.
Select the condition from the list. If it is not listed, use Add custom condition and enter the SNOMED code and display name manually.
Check Also record this on the patient's national record to share with the NHS national record.
Select + Add condition.
You can record multiple underlying conditions. They provide additional clinical context for the impairments recorded.
Note — Equality Act 2010 entry: The Equality Act 2010 condition ("Impairment with substantial and long-term adverse effect on normal day to day activity") is system-managed and displayed in a separate yellow banner below the underlying conditions list. It does not appear as a row in the conditions list, is not included in any counts or sync messages, and is not sent to or received from the NHS national record. It can only be removed by deleting the entire Reasonable Adjustment Flag.
Record consent and objections
Sharing reasonable adjustment information is based on implied consent — information is shared by default unless the client objects.
The objection section is visible on the Reasonable Adjustments page even before the flag has been activated. You can record a client's objection at any point.
Record an objection
On the Reasonable Adjustments page, scroll to the Objection section and select Record objection.
The modal opens showing the client's name, NHS number, date of birth, and gender.
Select a Reason for objection from the dropdown (mandatory).
Enter Additional comments (mandatory, up to 5,000 characters).
Read the warning and select Confirm.
⚠️ This action is permanent. Recording an objection permanently deletes all local RA data and removes the national record from NCRS. This cannot be undone. Only one objection can be held at a time.
Once confirmed, the page shows an Objection recorded label, the date and staff member who recorded it, and the Withdraw objection button. An amber warning appears: "Activation is blocked — an objection is recorded for this patient."
Withdraw an objection
On the Reasonable Adjustments page, scroll to the Objection section.
Review the objection detail — date, staff member, and comments recorded at the time.
Select Withdraw objection.
ACP retrieves the latest national record from NCRS. Any data returned is imported and displayed on the Summary tab.
⚠️ Previously recorded adjustments, impairments, and underlying conditions are not restored — they were permanently deleted when the objection was recorded. Only data currently held on the NHS national record is imported.
Review reasonable adjustments
Reasonable adjustments must be reviewed regularly to ensure they remain accurate and relevant.
On the Summary tab, select Mark as reviewed.
The Last reviewed date updates to today's date.
The Next review due date is set automatically to one year from today.
Dates display in dd-Mmm-yyyy format (e.g. 15-Sep-2026).
Sync with the NHS National Care Records Service (NCRS)
ACP connects to the NHS NCRS so reasonable adjustment information can be shared with other care providers. You need RADF Edit permission and your tenant must have an ODS code configured.
Pull existing data from NCRS
On the Summary tab, select Sync from NHS.
ACP retrieves the latest flag data from the NHS national record.
The sync status bar updates with the date and time of the last successful sync.
Submit to NCRS
On the Summary tab, select Re-synchronise to NHS.
ACP sends the flag data to the NHS National Care Records Service.
The sync status updates to Synced with the submission date.
📌 Note: If the NCRS is unavailable, ACP displays an error message. No cached data is shown — try again once the service is restored. If your tenant does not have an ODS code configured, contact your administrator to add one in Tenant → [your tenant name] → Edit before retrying.
View the audit history
Every change to a client's reasonable adjustment record is logged automatically.
On the Reasonable Adjustments screen, select the Audit History tab.
Events are listed most recent first, showing the event type, item name, SNOMED code (where applicable), staff member, and timestamp.
Use the All events dropdown to filter by event type, or the Search audit log field to find a specific entry.
Each entry shows the event type, detail, who made the change, and the date and time in dd-Mmm-yyyy HH:mm format.
Run the Reasonable Adjustments report
The RADF report lists all clients with an active reasonable adjustment flag. You need at least Restricted View (B0264) permission to run it.
Go to Reports in the main navigation.
Select Other Reports.
Select Reasonable Adjustments.
The report downloads immediately as an Excel file (.xlsx) — there is no configuration step.
The report includes one row per client with an active flag, sorted by branch then client name, and includes the following columns: Client Name, NHS Number, Branch, Flag Status (always Active), Impairments, Adjustments, Underlying Conditions, Last Reviewed Date, and Next Review Due.
The report is scoped to your accessible branches. Branch Admins see their assigned branches only. Tenant Admins see all branches, subject to their RADF permission role.
Delete the Reasonable Adjustment Flag
Deleting the flag permanently removes all reasonable adjustment data — locally in ACP and from the NHS national record. You need RADF Edit (B0380) permission.
⚠️ This action is permanent and cannot be undone. Local deletion proceeds regardless of whether the NCRS deletion succeeds. If the national record cannot be deleted, an error message is shown and you will need to contact NHS support.
Go to Reasonable Adjustments in the left-hand navigation.
Scroll to the bottom of the page and select Delete Reasonable Adjustment Flag.
The modal opens showing the patient's name, NHS number, date of birth, gender, and a summary of what will be deleted.
Select a Removal reason from the dropdown (mandatory): A best interest decision was taken to remove the item / A patient objection for the item has been upheld / A patient representative objection for the item has been upheld / The item no longer applies to the patient / The item was created in error.
Enter a Removal comment (mandatory, up to 5,000 characters, plain text only).
Select Continue, then confirm the deletion.
After deletion, the page returns to the pre-activation empty state. The flag can be re-activated from scratch if needed.
Permissions summary
ACP uses three permission levels for the Reasonable Adjustments feature, assigned by your administrator in the Roles settings.
Restricted View (B0264) — view adjustments only. Impairments and underlying conditions are hidden. Can run the Reasonable Adjustments report.
View (B0257) — view all sections (adjustments, impairments, underlying conditions, consent, audit history). Read-only. Can run the report.
Edit (B0380) — full access. Add, remove, activate flag, delete flag, submit to NCRS, sync from NHS, mark as reviewed, run the report.
Action | Restricted View | View | Edit |
View the Reasonable Adjustments section | ✓ (adjustments only) | ✓ | ✓ |
View impairments | — | ✓ | ✓ |
View underlying conditions | — | ✓ | ✓ |
View consent / objection status | — | ✓ | ✓ |
View audit history | — | ✓ | ✓ |
Run the Reasonable Adjustments report | ✓ | ✓ | ✓ |
Activate the flag | — | — | ✓ |
Add / remove impairments | — | — | ✓ |
Add / remove adjustments | — | — | ✓ |
Add / remove underlying conditions | — | — | ✓ |
Record / withdraw objection | — | — | ✓ |
Mark as reviewed | — | — | ✓ |
Sync from NHS | — | — | ✓ |
Re-synchronise to NHS | — | — | ✓ |
Delete the flag | — | — | ✓ |
Contact your administrator to request access if you cannot see the Reasonable Adjustments section.