Orthodontic care depends on communication. Patients have to understand a treatment plan, follow cleaning and wear instructions for many months, and return for regular visits. For disabled patients and those with sensory loss, a plan that is explained only in small print, by phone, or in a cramped surgery can quietly become a barrier to care. This guide explains reasonable adjustments and the Accessible Information Standard in an orthodontic practice: what the law requires, what the NHS standard asks you to do, and how to build simple, low-cost habits into booking, consultation, treatment and follow-up. Key takeaway The Equality Act 2010 requires service providers to take reasonable steps to avoid substantial disadvantage to disabled people, including providing information in an accessible format, and a provider cannot make the disabled person pay the cost. The NHS Accessible Information Standard, in force since August 2016, requires all organisations providing NHS care, including dentists, to ask, record, flag, share, act on and review patients' communication needs. Under section 20 of the Equality Act 2010, a provider must take reasonable steps to avoid the substantial disadvantage that a disabled person would otherwise face, and cannot charge the disabled person for the cost of the adjustment. The Act describes three requirements. The first applies where a provision, criterion or practice puts a disabled person at a substantial disadvantage compared with people who are not disabled, for example a policy that appointments can only be booked by phone. The second applies to a physical feature, such as steps to the front door or a waiting-room layout. The third applies where a disabled person would be at a substantial disadvantage without an auxiliary aid, such as an induction loop or a sign language interpreter. Two further points are worth noting. Where the first or third requirement relates to the provision of information, the reasonable steps include making sure information is provided in an accessible format. And the Act says that a person subject to the duty is not, subject to express provision to the contrary, entitled to require the disabled person to pay any of the cost of complying. In practice that means no surcharge for a longer appointment, a large-print plan or an interpreter. What counts as reasonable depends on circumstances such as the size of the practice and the cost and effectiveness of the step, so keep a short written record of what you considered. 3 Requirements of the section 20 duty: practices, physical features and auxiliary aids Aug 2016 Date the Accessible Information Standard has been in force, according to NHS England 6 Implementation steps in the NHS standard: ask, record, flag, share, act and review The Accessible Information Standard sets out how providers of NHS care and publicly funded adult social care should make sure disabled people and people with impairments or sensory loss can access and understand information and receive the communication support they need. NHS England states that all organisations providing NHS or adult social care services must have regard to it, and its guidance lists private organisations providing NHS services, such as dentists, among those covered. The legal basis is section 250 of the Health and Social Care Act 2012. If your orthodontic practice holds an NHS contract, the Accessible Information Standard applies to your NHS patients, and it is sensible good practice for private patients too. NHS England notes that complying with the standard also helps organisations meet their obligations under the Equality Act 2010. The standard is not assured by CQC, which is the role of commissioners, but NHS England says an organisation's performance in meeting people's needs is considered in CQC assessment and ratings. NHS England sets out six implementation steps. Each translates into a clear task for an orthodontic team. NHS England says the standard's aim is that people can contact, and be contacted by, services in accessible ways, for example by email or text message, receive correspondence in formats they can read such as audio, braille, easy read or large print, and be supported by a communication professional at appointments if needed, for example a British Sign Language interpreter. It also expects an accessible complaints process. Our blog on the CQC-compliant complaints procedure is a good place to check the final point. Think of the patient journey as a series of touchpoints and ask at each one, what would stop a disabled patient from taking part? The list below is deliberately practical. Before the visit Website, enquiry form, booking and reminders. The consultation Explaining diagnosis, options, costs and consent. In the surgery Reclined chair, bright light, masks and noise. During treatment Cleaning, elastics, wear schedules and emergencies. Payments and consent Quotes, finance agreements and consent forms. After treatment Retainer instructions and reviews. Our guides to orthodontics for patients with special needs, orthodontics for autistic and ADHD patients and orthodontics and learning disability include clinical considerations that complement the communication steps here. Many adjustments are inexpensive or free. The table gives examples of steps a practice can take, with the barrier each one addresses. Whether a step is reasonable depends on the practice and the circumstances, so treat it as a prompt rather than a checklist. Important The Equality Act places the duty on the practice, and the practice cannot pass on the cost. If a disabled patient needs an interpreter, budget for it as a business cost rather than adding it to the fee. The PHE safeguarding toolkit also advises against using family members, friends or untrained members of the community as interpreters, because there is no assurance about what is being said. Our consent process guide explains why understanding is part of valid consent. Standardise how needs are recorded Virtual Consultant Online stores patient records, quotes and communications in one pipeline, so a recorded need can travel with the patient from first enquiry to retention. Try the patient quote journey → For many patients, the first contact with an orthodontic practice is online. Accessibility on the web is a practical part of reasonable adjustments, even though public sector accessibility regulations do not automatically apply to private practices. A sound benchmark is the Web Content Accessibility Guidelines (WCAG), which cover colour contrast, text alternatives for images, keyboard navigation, form labels and captions on video. Run a quick check by tabbing through your booking form with a keyboard, zooming your pages to 200 percent and listening to the page with a screen reader. Our orthodontic website essentials for 2026 and digital patient onboarding guide cover the content patients look for, and you can fold accessibility into both. Digital tools help when they offer choice rather than replace it. Online forms and remote consultations can remove travel barriers for some patients, but they can create new ones for others, such as people who cannot use video or read small screens. Keep a phone and in-person route available and ask every patient how they would prefer to be contacted. Our guide to WhatsApp and SMS communication discusses channels in more detail. Review progress after 30 days and again at the practice's annual policy review. The NHS England self-assessment framework is a free tool you can use to see how well you meet the standard, and its guidance suggests working from basic through intermediate and advanced to exemplar levels, rather than trying to reach the top at once. Give every patient a clear route into care Try the online quote to see how a patient can start their journey digitally, with their details and communications kept together in one record.What does the Equality Act 2010 require?
What is the Accessible Information Standard?
The six steps in an orthodontic practice
Step NHS England wording What it looks like in an orthodontic practice Ask Find out if people have communication and information needs A question on the new patient form and at the first consultation: do you need information in a particular format or any communication support? Record Record needs in a clear and standardised way A consistent field in the patient record, not free text hidden in notes Flag Use alert systems to generate specific formats or indicate needs A visible alert that appears when the record is opened and when letters are generated Share Include records in data sharing and referral processes Include the need in referral letters and when transferring care, with appropriate consent Act Take steps to make sure needs are met Book the interpreter, print the large-print plan, allow longer time or choose a quieter slot Review Regularly review needs and keep records up to date Re-ask at the debond, at each phase change and when contact details are checked Where do barriers appear in the orthodontic journey?
Common reasonable adjustments, and what they cost
Barrier Possible adjustment Typical effort Hearing loss Induction loop, text or email contact instead of phone, face-to-face speaking position, written summaries Low to moderate Sight loss Large print or audio plan, a guide to the surgery layout, a text-to-speech friendly website Low Language or communication needs Qualified interpreter, BSL interpreter, pictures, easy-read leaflets Moderate, per use Learning disability or autism Longer appointment, advance visit to the surgery, a familiar clinician, a visual schedule Low Mobility Step-free access, accessible toilet, a ground-floor surgery for appointments Moderate if the building must change Anxiety or sensory sensitivity Quiet appointment times, headphones, tell-show-do explanations, breaks Low Making your website and digital journey accessible
A simple 30-day action plan
Reasonable Adjustments and the Accessible Information Standard: A Practical Guide for Orthodontic Practices
Published · 9 min read · by Virtual Consultant Online
Offer more than one way to contact you, avoid text-only images, and make sure online forms work with a screen reader.
Allow extra time, give a written summary in plain English, and use teach-back to check understanding.
Explain each step before it happens, allow breaks, and let patients who lip-read see the clinician's face where possible.
Use pictures or short videos, an easy-read care sheet and a simple route for urgent contact.
Offer large print or a walk-through, and avoid relying on a signature without checking comprehension.
Re-ask about needs at debond and send retainer guidance in the patient's preferred format.
Add the ask question to your new patient form and your online enquiry form
Create a single field and visible alert for communication needs in your patient record
Save a template for large-print and easy-read treatment summaries
Identify your interpreter and BSL booking routes and the budget owner
Check physical access: step-free entrance, signage, accessible toilet, waiting-room layout
Train reception to ask the question calmly and consistently
Test your website and forms with a keyboard and screen reader
Record the reasonable adjustments you considered and the steps you took
Citation and AI access
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References
The legal text setting out the three requirements of the reasonable adjustments duty and the rule that disabled people cannot be charged.
Equality Act 2010, section 20: Duty to make adjustmentsNHS England overview of who the standard applies to and how it helps organisations meet Equality Act obligations.
NHS England: Accessible Information StandardThe six implementation steps and the list of organisations covered, including dentists providing NHS services.
NHS England: How to meet the Accessible Information StandardToolkit for dental teams, including guidance on interpreters and equality duties.
Public Health England: Safeguarding in general dental practiceThe legal text setting out the three requirements of the reasonable adjustments duty and the rule that disabled people cannot be charged.
Equality Act 2010, section 20: Duty to make adjustmentsNHS England overview of who the standard applies to and how it helps organisations meet Equality Act obligations.
NHS England: Accessible Information StandardThe six implementation steps and the list of organisations covered, including dentists providing NHS services.
NHS England: How to meet the Accessible Information StandardToolkit for dental teams, including guidance on interpreters and equality duties.
Public Health England: Safeguarding in general dental practice