Reasonable Adjustment Flag (RAF)

How do I use it?

This information is visible in SCR/NCRS, enabling pharmacy teams to review it to support safe, person-centred care.

Refreshing your knowledge with the NHS How to use the NHS RADF in NCRS guide and RDAF e-learning can help ensure your team understands what reasonable adjustments are and how they can support people effectively.

Why is this relevant for pharmacy?

Pharmacy owners have a legal duty under the Equality Act to make reasonable adjustments for patients who need them. For example, you might need to change how you provide medicines or advice.

The RAF can help you spot when a patient may need extra support. It gives you a quick alert and points you to more details in shared records or care plans. But you still need to make your own assessment and decide what adjustments are appropriate.

• The RAF is made visible through the NCRS portal and Spine information.
• Health and care professionals can view, add, or update RAF information.
• Access is controlled by NHS Smartcards and Role-Based Access Controls (RBAC).
• Administrative staff can see that a flag exists, but cannot view the details unless they have the correct permissions.
• In future, the RAF will link to other systems using FHIR (Fast Healthcare Interoperability Resources) standards for better integration once IT suppliers and NHS IT teams have progressed IT standards and integration routes.

What does the RAF include?

• Key adjustment details taken from local records.
• Pick lists of common adjustments (e.g. communication needs under the Accessible Information Standard).
• Space for bespoke notes about individual patient needs.
• A clear red circle indicator in SCRa next to the patient’s demographics.

Important points to be aware of

• The RAF does not replace your professional judgment.
• You decide what medicine-related adjustments to make after assessing the patient, and viewing the information in the RAF, rather than another pharmacy or another healthcare provider.
• The Equality Act does not require a formal assessment for every interaction.
• RAF information can support your decision-making, but does not override your usual protocols.

The NHS has introduced a new Information Standard for the Reasonable Adjustment Digital Flag (RADF). This standard outlines how health and care providers can record and share information about patients who require reasonable adjustments under the Equality Act 2010.

A cross-sector NHS communication indicated that by 30th September 2026, healthcare providers must have the capability to:

The RAF was first piloted in 2019 with patients who had learning disabilities in Gloucester and Devon. NHS England has since expanded its use nationally.

Initially, specialist teams such as memory clinics and learning disability services populated the RAF information. Wider rollout continues, and pharmacy teams may increasingly encounter patients with RAF indicators in the NCRS as it rolls out to more sectors over time and becomes more comnmonly used.

Q. What’s changing for community pharmacy?

Community pharmacies already provide reasonable adjustments and can already view RADF information through NCRS.

What’s new is that the NHS is now enabling this information to be recorded and shared consistently across all care settings. This means staff in other healthcare settings will see the same information that you see in the pharmacy.

For pharmacy teams, this brings practical benefits:

• RADF information will be easier to find when you need it (over time, as RADF and NCRS improvements occur)
• information will be more consistent across NHS services
• communication between providers will be smoother
• duplication will be reduced for both patients and staff

The RADF is designed to support your existing processes — not add new steps or replace what you already do.

Q. Do community pharmacy teams need to contact their IT supplier?

No. Pharmacy teams do not need to contact their system supplier about the RADF.

NHS England is already working with pharmacy IT suppliers to explore how future updates could make RADF information easier to view or record within more pharmacy IT systems, while reducing workload.

Community Pharmacy England and NHS England will update the sector as soon as new functionality becomes available.

Q. How can the RADF help your team?

The RADF can help you make more informed, person-centred decisions by giving quick background information, especially when:

• you are meeting the patient for the first time
• needs are not immediately obvious
• you want to understand communication preferences
• you are providing a clinical service such as Pharmacy First

However, the RADF does not:

• instruct you to take any specific action
• replace your usual assessment of a person’s needs
• remove the need for professional judgement
• override existing pharmacy protocols

Your team remains responsible for deciding what is safe, appropriate and reasonable for each patient. Read more about your existing responsibilities in our guidance on the Equality Act 2010.

Q. Should the RADF be used to record a patient’s preference for Monitored Dosage System (MDS) trays?

Usually no.

The RADF is designed to record information about reasonable adjustments under the Equality Act 2010. It helps other health professionals understand a patient’s needs, but it does not replace your own assessment or dictate what a pharmacy must do or supply.

For MDS trays and other medicine-related adjustments, pharmacy owners should continue to make decisions based on their own assessment of the patient.

The RADF can provide helpful context (e.g. the “needs assistance with medication regimen adherence” flag), but the RDAF:

• cannot instruct a pharmacy to supply an MDS
• does not override professional judgement
• does not replace local assessment processes
• cannot be used by other healthcare providers to require a community pharmacy to take specific actions

Responsibility for the final decision always sits with the pharmacy team.

Q. Who can amend the RADF and what should pharmacy teams expect in practice?

Different NHS teams can update RADF entries when appropriate and within their professional scope. For example:

• memory clinics may add adjustments to support people living with dementia
• hospital teams may record communication or sensory needs identified during an inpatient stay
• community health teams may update entries after structured assessments

What this means for community pharmacy:

• pharmacy teams can add information if appropriate, but this is not routinely expected
• most updates will naturally happen in other settings during longer appointments
• if a patient wants to change or add something, the best advice is for them to raise it at their next suitable appointment with the team who knows them best

This approach helps ensure updates remain accurate, clinically appropriate and manageable for pharmacy teams.

Q. How does the RADF support your equality duties?

The RADF is a tool that helps the NHS meet its responsibilities under the Equality Act 2010, but it does not replace the duties that pharmacy owners themselves hold under the Act.

Pharmacy teams must still:

• identify when a person may face barriers accessing services
• consider and make reasonable adjustments where appropriate
• record decisions in line with local procedures
• use professional judgement to determine what is safe and reasonable

The RADF helps ensure that information about a patient’s needs is not lost when they move between different NHS services.It reduces the need for patients or carers to repeat sensitive information and helps your team make informed decisions more quickly and confidently.

Pharmacy teams may find RADF information especially helpful during:

• consultations where you are meeting a patient for the first time
• Pharmacy First and other clinical services
• home delivery or local support services
• understanding a person’s communication preferences
• supporting patients transitioning between care settings

Community Pharmacy England will continue working with NHS England and pharmacy IT suppliers to seek to ensure that the RADF genuinely supports safer, more inclusive and more efficient care — without increasing workload for pharmacy teams.

Q. What does this mean for your everyday practice (in summary)?

Pharmacy teams can:

• continue to view RADF information in NCRS
• use it to understand patient needs more quickly
• continue to apply professional judgement when deciding what is safe and reasonable

Pharmacy teams are not expected to:

• record every possible adjustment
• check the NCRS portal for every patient in case of a flag
• replace normal assessments with the RADF
• rely on RADF information as a mandate for action
• contact their system supplier

The RADF supports your work — it should not increase burden or replace your professional decision-making.

• Equality Act 2010 and Monitored Dosage Systems (MDS) (quick reference Community Pharmacy England guide)
• Equality Act 2010 and MDS
• NHS Reasonable Adjustment Flag webpage
• e-Learning for Healthcare – Reasonable Adjustment Digital Flag