The Equality Act 2010
Published on: 19th July 2013 | Updated on: 14th April 2022
From 2005, the funding of the NHS Pharmaceutical Services has included an element to recognise the additional cost of complying with disability legislation.
The Royal Pharmaceutical Society has published guidance on the better use of multi-compartment compliance aids and this should be considered by pharmacists.
Accessible information standard
On 24th June 2015, NHS England issued an information standard aimed at making health and social care information accessible. Pharmacy contractors must comply with the information standard no later than 31 July 2016.
Pharmacy contractors should review the material NHS England has published to inform and assist in the implementation of the information standard (NHS England accessible information standard, specification and implementation guidance documents).
In July 2015, we also produced PSNC briefing 039/15 which is another available resource.
In April 2016, PSNC and Pharmacy Voice jointly produced this update for those working in community pharmacy: The Accessible Information Standard: Update on implementation in community pharmacy.
The accessible information standard appears to outline guiding principles rather than prescriptively impose obligations as to what is specifically required for contractors to comply with it. This means that there is no “one size fits all” and the policy intent here seems to be for substance to take priority over form – two pharmacy contractors may go about asking, recording, sharing and acting upon a patient’s information or communication needs in different ways but could be equally compliant with the accessible information standard. A practical example of how this could manifest itself in practice could be a blind or partially sighted person could communicate to the pharmacy contractor that they cannot see or experience difficulty in reading printed information. If that person agrees to receive information via text or e-mail – e.g. if they already have talking software on their computer/tablet, then this would likely be an action that many community pharmacies could take to meet an expressed communication need. We will all probably have ideas as to what “meeting the standard” means and in practice most community pharmacies are likely to already be doing (to varying degrees) what is required by the accessible information standard. Community pharmacies asking, recording, sharing (where appropriate – protecting patient confidentiality) and acting to ensure that patients receive information which they can access, understand, and receive communication support, if they need it, are the take away points.
PSNC have made representations to NHS England regarding the administrative burden associated with implementing the accessible information standard. We remain committed to ensuring that the accessible information standard is implemented in the most reasonably practicable way as can be agreed.
Community pharmacies should be aware that patients may inform them about their specific accessible information and / or communication needs as support organisations involved with patients who have accessible information and / or communication needs, will be publicising and promoting the obligations under the information standard of all providers of NHS and adult social care services in England – which include community pharmacies.
As and when community pharmacies are informed of accessible information / communication needs these should be recorded and action taken to meet these needs, as appropriate.
Further information and support can be sought from a number of charities including Action on Hearing Loss, CHANGE, Sense, and the Royal National Institute of Blind people (RNIB).
Q. I am trying my best to meet service users’ accessible information and / or communication needs. Is there any further guidance?
NHS England has made clear that there is “no one size fits all” approach – it is very much for pharmacy to implement the information standard with local services in a way which works for the pharmacy and the patients – it needs to be flexible. There is no expectation to reinvent the wheel and pharmacy contractors are encouraged to use and develop existing systems e.g. for recording accessible information / communication needs and action/s taken to meet them.
Clearly, there is a related commercial aspect to this – if patients do not get adequate access to information and / or their communication needs met then they may choose to use another pharmacy. The information standard in some ways formalises what community pharmacies are already doing in terms of meeting patients’ accessible information / communication needs.
PSNC is continuing to work with the other representative bodies for GPs, Optometrists and dentists together with representatives from Pharmacy Voice. Further consideration is being given to developing some “standard” guidance which is expected to be available in due course – though note that this does not detract from “no one size fits all” approach which NHS England has made clear is applicable.
Pharmacies may find various disability support organisations such as the Royal National Institute for the Blind (RNIB), British Deaf Association, Health Watch, Sense, Royal Association of Deaf people can provide resources / training to help in the information standard implementation e.g. Patient Information Leaflets (PILs) in different formats at the Electronic Medicines Compendium (EMC) which provides a database of up to date PILs, viewable in different font sizes.
In addition, MENCAP’s “Hospital Communication Book” has been developed to help people who have difficulties understanding and / or communicating get an equal service in hospital– which could be useful.
NHS England announced plans for a post-implementation review during January to March 2017 to look at:
- how organisations have implemented the Standard;
- the impact of the Standard, including organisations’ and service users’ experiences;
- any aspects of the Standard which need updating or clarifying.
NHS England indicated that as part of the review, individuals and organisations will be able to feedback on their experiences and make suggestions. Following the review, NHS England will publish a report.
During January-March 2017, NHS England conducted a review of the information standard to assess impact and check that it is ‘fit for purpose’.
PSNC submitted its response to the review.
Following the post-implementation review of the information standard, NHS England published revised versions of the Specification and Implementation Guidance though there have been no substantive changes to the Requirements of the Standard nor to the overall scope.
Optical Federation Guidance
The Optical Federation produced and published guidance on the information standard which although, specifically aimed at NHS Opticians should be helpful to NHS Pharmacy Contractors whom also provide NHS services
NHS England’s Accessible Information Standard webpage: www.england.nhs.uk/accessibleinfo
An interactive programme on implementing the Standard: Accessible Information Standards programme
CPPE e-learning programme
In April 2016, CPPE launched the Accessible Information Standard (AIS) a new e-learning programme, Accessible Information Standard – making it work.
During the programme learners will be able to discuss their responsibilities as a team member with regards to the AIS, identify patients with communication difficulties and devise effective solutions to meet their needs. They will also be able to train other pharmacy members to help them implement the AIS requirements.
28 day prescribing
PSNC is sometimes asked about the impact of the Equality Act on the period of treatment, and whether adjustments must be made in the period of treatment specified on a prescription, where the patient may require a multi-compartment compliance aid. The following guidance seeks to answer those queries.
Many of the queries that PSNC receives about support for patients who have a disability concern requests from prescribers carers and relatives to dispense weekly into compliance aids. The NHS Terms of Service do not impose a requirement to dispense into compliance aids or to dispense in instalments (other than instalment prescriptions for the treatment of substance misusers). Therefore a prescription ordering treatment for 28 days should be dispensed on one occasion. It is for the pharmacy contractor to decide whether it is appropriate to dispense into a compliance aid.
If a prescription for 28 days’ treatment is issued for a patient who satisfies the Equality Act 2010 criteria, and the pharmacy contractor decides that the adjustment required is a compliance aid, then 4 x 7 day compliance aids or 1 x 28 day compliance aid should be prepared on one occasion.
There is no obligation under the Terms of Service or within the Equality Act 2010 for the pharmacy to amend what has already been dispensed, mid-way through a course of treatment. Therefore, alterations to treatment should be authorised by the production and dispensing of another prescription, with the previously dispensed items discarded.
If a patient’s medicines are dispensed in compliance aids because of an established need under the Equality Act 2010, and an additional medicine is prescribed during the time that the compliance aid is in use, this should result in a completely new compliance aid being prepared. Dispensing a separate container of the ‘new’ medicine to be used in conjunction with the previously supplied compliance aid would cause confusion and could result in the medicines not being taken appropriately.
As stated above, there is no obligation on pharmacy contractors to amend what has already been dispensed, so the prescriber would be obliged to make an Equality Act 2010 adjustment, by issuing a prescription for all the current medicines, so that they can all be dispensed into a new compliance aid. For this reason, prescribers could be advised to issue 7 day prescriptions, if the patient frequently has changes made to prescribed medicines.
Where prescribers order in 28 day (or longer) periods, but recommend that the medicines are dispensed weekly, or in compliance aids (for patients not entitled to this support under the Equality Act), this should be facilitated by a locally commissioned service.
PSNC Briefing 060/17 Equality Act 2010 a quick reference guide (updated September 2017)
This PSNC Briefing aims to confirm and clarify key aspects of our main guidance below.
PSNC Briefing 001/16 Equality Act 2010 (January 2016)
This PSNC Briefing updates “PSNC Briefing 084/13: Equality Act 2010″on the Equality Act 2010 (incorporating its predecessor legislation the Disability Discrimination Act 1995).
The Specialist Pharmacy Service (SPS) in collaboration with the pharmacy team at Moorfields Eye hospital and the Royal National Institute for Blind people have developed guidance of how pharmacy professionals can support blind and partially sighted patients and/or carers.
Public Health England Pharmacy and people with learning disabilities: making reasonable adjustments to services (June 2017)
PSNC Briefing 054/16: Medicines Wastage and Prescription Duration (October 2016)
This PSNC Briefing updates PSNC Briefing 086/13: Medicines Wastage and Prescription Duration, which summarises information on prescription duration and medicines wastage. This Briefing also highlights literature on the environmental impacts of waste medicines which are not disposed of correctly.
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