Accessibility Spot-Check (Owner Edition): 5 Things You Can Verify Today

Introduction: Why Accessibility Spot-Checks Matter for GP Practices

For GP practices and healthcare providers, digital accessibility is not optional. It is central to safe care, equity, and compliance with the Public Sector Bodies (Websites and Mobile Applications) (No. 2) Accessibility Regulations 2018 and the Equality Act 2010. NHS England’s digital accessibility standards expect services to meet WCAG 2.2 AA and follow the NHS Service Standard and NHS design guidance.

The good news: as a practice manager, clinical lead, or comms owner, you do not need to be a developer to catch many high‑impact issues. A simple “owner edition” spot-check on your homepage can reveal whether your site is broadly on the right track or at risk of excluding patients.

This blog walks you through a practical, repeatable 5‑point check you can complete in under an hour, then explores common pitfalls, why overlays are not a fix, and when it is quicker to rebuild with accessible components.

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The 5‑Step Accessibility Spot-Check You Can Do Today

Step 0: Run a Free Browser Extension Scan

Before any manual checks, run an automated accessibility checker on your homepage. This will not catch everything, but it will surface obvious technical issues and give you a simple list to discuss with suppliers. What to do

• Install a free extension such as WAVE or axe in your browser.
• Open your practice homepage.
• Run the scan and review the issues.

What to look for

• Critical errors such as missing alt text on key images, low colour contrast, empty links/buttons, missing form labels.
• Structural issues such as no heading level 1 (H1), skipped heading levels, or landmark issues (for example, no main content region).
• Repetitive patterns like the same error appearing across multiple elements (for example, all buttons failing contrast).

If your homepage is already full of red flags, it is likely the rest of the site has similar problems. Use this as an early warning, not the final verdict.

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Step 1: Contrast – Can You Read Text at a Glance?

Poor colour contrast is one of the fastest ways to make your site unusable for patients with visual impairments, older patients, and anyone using a device in bright light. WCAG 2.2 AA requires sufficient contrast between text and background.

Quick owner test

• Open your homepage on a laptop and a mobile.
• Look at key areas: surgery name, “Contact us”, appointment links, login buttons for NHS App, links to e-consult or online consultation, urgent care information.
• Ask yourself: Can I read this easily at a glance without squinting or zooming?

Practical checks

• Main body text
• Is it at least 16px (or clearly readable)?
• Is it dark text on a very light background (or vice versa), not pale grey on white? Buttons and key calls to action
• Are labels like “Book appointment”, “Order repeat prescription” and “Contact the practice” clearly visible?
• Does text on coloured buttons stand out clearly from the background?
• Link text
• Are links clearly distinguishable from surrounding text (colour + underline or other clear visual cue)?

Small copy/design changes with huge impact Colour and style tweaks

• Darken link colours and ensure they are also underlined in body text.
• Avoid using colour alone to indicate a state (for example, green for “available”, red for “not available” without text).

Content tweaks

• Replace vague link text like “Click here” with meaningful phrases:
  • “Book a GP appointment online”
  • “Order repeat prescription”
  • “Find out how to register with the practice”

These small changes improve usability and help meet WCAG success criteria around contrast and meaningful link purpose.

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Step 2: Keyboard – Can You See Where You Are When You Tab?

Many patients navigate using keyboard only, speech recognition, or assistive technology. NHS digital accessibility guidance explicitly expects services to be usable with just a keyboard. Quick owner test

• On your homepage, do not use the mouse.
• Press the Tab key repeatedly and watch what happens.

What should happen

• You should see a visible focus outline (usually a box or highlight) move from link to link and button to button.
• Focus should start at the top (often a “Skip to main content” link), then move through the menu, search, main content, and footer.
• When focus lands on a button (for example, “Submit”, “Search”), pressing Enter or Space should trigger it.

Red flags

• You cannot see where you are (no focus outline at all, or so faint it is effectively invisible).

• You get “stuck” on elements or trapped in menus or pop-ups.

• Important controls (for example, appointment or prescription links, forms, cookie banners) are not reachable via Tab.

• A mega‑menu opens on focus but cannot be closed with Esc or by tabbing away. Simple, practical actions

• Ask your web supplier or IT team to:

  • Ensure visible focus styles are not removed by CSS.
  • Fix any elements that are not keyboard focusable (for example, clickable icons coded as plain <div> without proper roles).
  • Make menus and pop-ups closeable with keyboard controls (Esc and standard tabbing).

For GP practices, this is particularly important for:

• Online triage or consultation links
• Prescription ordering links
• NHS App login guidance and links
• Accessibility statement and complaints/feedback routes

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Step 3: Alt Text – Are Key Images Described?

WCAG and NHS standards require informative images to have meaningful text alternatives (alt text) so screen reader users can understand the content. Quick owner test

You can spot-check alt text without specialist tools:

• In most browsers, right-click an image and choose “Inspect” or “View source” to see if alt="..." is present and meaningful.
• Or use WAVE/axe to highlight images missing alt attributes.

What to check

Focus on key images that carry information, such as:

• Practice logo (often read as site name)
• Banners advertising flu clinics, new online services, or urgent changes to access
• Icons used instead of text for important actions (for example, a telephone symbol or envelope icon that is the only indication of contact method)

Good vs poor examples Good alt text

• “Westside Medical Practice logo”
• “Book your flu vaccination – clinics available from October”
• “Call the surgery on 01632 960123”

Poor or missing alt text

• alt="image123.jpg" or alt="banner"

• No alt attribute at all on an image that conveys essential information Practical actions

• Ask content editors and suppliers to ensure:

  • Key images have meaningful alt text.
  • Decorative images (for example, background patterns) are marked as decorative (empty alt attribute) so they are skipped by screen readers.
  • Update alt text templates in your CMS so editors are prompted when uploading images.

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Step 4: Headings – Do H1s and H2s Make Sense?

Headings are not just visual. Screen reader users rely on them to navigate quickly, and WCAG requires a logical heading structure. NHS organisations’ accessibility statements often acknowledge problems when this structure is not followed. Quick owner test

• Skim your homepage visually.
• Read the main headings as if they were a contents list.

Ask:

• Is there one clear H1 that describes the page (for example, the practice name or “Welcome to…” statement)?
• Do H2s break the page into meaningful sections (for example, “Appointments”, “Prescriptions”, “Test results”, “Opening times”)?
• Could someone understand the main structure of the page just from reading the headings?

You can also use browser extensions (including WAVE) to list headings and see their levels. Red flags

• No clear H1, or multiple H1s used for styling.
• Heading levels skipped randomly (for example, H1 then H4 then H2).
• Things that look like headings visually but are coded as normal text.
• Headings used for emphasis only, not to structure content (for example, every line styled as a heading).

Practical improvements Improve hierarchy

• Ensure each page has one H1, usually the page title.

• Use H2 for main sections; H3 only where you genuinely have subsections. Improve wording

• Replace vague headings like “Information” or “More” with specific, task-focused titles:

  • “How to book an appointment”
  • “How to order repeat prescriptions”
  • “When to call 999 or 111”

This makes pages more scannable for all patients and easier to navigate with assistive tech.

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Pass or Fail: Making a Simple Call

For an owner‑level spot check on your homepage, you can use a clear rule of thumb:

• Pass:

  • No critical issues in your automated scan.
  • Text is readable at a glance.
  • Keyboard focus is visible and you can access key functions without a mouse.
  • Key images have meaningful alt text.
  • Headings form a logical, understandable structure.

• Fail:

  • Any of the above is clearly missing.
  • Automated tools show critical errors affecting key journeys (appointments, prescriptions, contact).

A “fail” on your spot-check does not mean your entire site is non‑compliant, but it is a strong signal you need to prioritise accessibility improvements and potentially plan a more formal audit.

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Why Overlays Aren’t a Fix

Many public-sector sites are approached by vendors offering “one line of code” overlays that claim to instantly fix accessibility and meet regulations. These often add a toolbar to change contrast, text size, or “screen reader mode.”

For GP practices and NHS organisations, relying on overlays is risky.

Key problems with overlays They do not fix underlying code

• Overlays try to modify the page in the browser, but they do not correct poor HTML structure, missing labels, or broken keyboard navigation.

• WCAG compliance and UK regulations expect your underlying service to be accessible, not only when an overlay is turned on. They can interfere with assistive technologies

• Many users with disabilities already have their own tools (for example, screen readers, browser zoom, custom styles).

• Overlays can conflict with these tools, creating unexpected behaviour, repeated content, or confusing focus order.

They create a false sense of security

• Owners may believe, “We’ve installed an accessibility widget, so we’re covered,” and stop addressing real issues in templates, components, and content.
• Regulators and auditors look for evidence of WCAG compliance and ongoing improvements, not the presence of an overlay.

For NHS and GP websites, best practice is to:

• Fix core templates and components.
• Follow the NHS Service Manual and WCAG 2.2 AA directly.
• Use accessibility statements to be honest about issues and what you are doing to improve.

Overlays can be at best a minor supplementary aid for some users; they are not a route to compliance.

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Small Copy Changes with Huge Impact

You do not need a complete redesign to make a meaningful difference. Thoughtful content changes can remove barriers quickly.

Plain language

• Replace jargon with everyday words:

  • “Clinician” → “Doctor, nurse or other healthcare professional”
  • “Triage” → “We will ask you some questions to decide the best type of appointment”
  • Break complex instructions into short steps (ideal for registration, changing address, ordering prescriptions). Task-focused headings and links

• Use clear headings that match common user tasks:

  • “Check your test results”
  • “Register as a new patient”
  • “Request a fit note”
  • Make links self-explanatory:
    • Instead of “Click here”, use “Complete an online consultation form”.

Clear signposting for urgent care

• Prominently state when patients should:
  • Call 999
  • Call NHS 111
  • Contact the surgery
  • Use short, direct phrases:
    • “Call 999 now if you or someone else has a serious or life‑threatening emergency.”

These content decisions support accessibility, safety, and patient understanding, and are strongly aligned with NHS content design guidance.

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Where Errors Usually Hide: Forms and Menus

Once your homepage passes the basic spot-check, the next step is to look at the two areas where accessibility problems commonly cause real‑world harm: forms and navigation menus.

Forms: Registration, Contact, and Clinical Triage

Online forms are critical for registration, appointment requests, and clinical information. If they are not accessible, some patients effectively cannot register or request help. Common form issues

• Form fields without labels, or labels not linked to inputs.
• Placeholder text used instead of labels.
• Poor error messages (for example, “There was an error” with no detail).
• Error messages that appear only in colour without text or icon.
• Date pickers and complex widgets that are not keyboard accessible.

Owner test for forms

• Navigate a key form (for example, new patient registration or online contact form) using only your keyboard.
• Check:
  • Does each field clearly tell you what to enter?
  • If you submit the form with errors, are the errors clearly explained and easy to find?
  • Can you complete every field without using a mouse?

Menus and Navigation

Complex menus can become a serious barrier for people using screen readers or keyboards. Common menu issues

• Hover-only menus that never open with keyboard focus.
• Menus that trap keyboard focus or cannot be closed.
• Tiny hit‑areas for touch users on mobile.
• Multiple levels of nested links without clear headings or grouping.

Owner test

• On desktop, use Tab and arrow keys to move through the navigation.
• On mobile, check that:
  • The “hamburger” or menu button is labelled meaningfully (for example, “Menu”).
  • Menu items are large enough to tap easily.
  • Once you open a menu, you can easily close it and return to the main content.

These areas often require development work to resolve, but identifying them helps you prioritise and hold suppliers to account.

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Rolling Monthly Checks: Making Accessibility Part of BAU

Accessibility is not a one‑off project. NHS organisations are increasingly moving towards a continuous improvement model, reviewing accessibility on a regular basis.

For a GP practice or PCN site, a light‑touch monthly spot‑check can be realistic and effective. What to include in a monthly check

Homepage review

• Re-run WAVE/axe on the homepage.

• Repeat the 5‑step manual check (contrast, keyboard, alt text, headings, pass/fail). Key journey checks

• Choose one or two critical user journeys each month, for example:

  • Booking an appointment
  • Requesting a repeat prescription
  • Registering as a new patient
  • Accessing test results information
  • Walk through them:
    • On desktop and mobile
    • With keyboard only
    • Checking that content is clear and headings make sense

Content updates

• Ensure new content follows the same accessibility principles:

  • Alt text for images
  • Clear headings and link text
  • Avoiding PDFs unless strictly necessary; using HTML pages where possible, in line with many NHS organisations’ moves away from PDFs. Recording and planning

• Maintain a simple log:

  • Date checked
  • Pages or journeys tested
  • Issues found
  • Actions taken or requested from suppliers
  • Use this log to support your accessibility statement and demonstrate due diligence if challenged.

This approach is aligned with how many NHS organisations now commit to regular reviews in their accessibility statements.

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When It’s Faster to Rebuild with Accessible Components

Sometimes, incremental fixes become more expensive and fragile than starting again with a robust, accessible foundation.

For GP practices, this often arises when:

• The current website is based on a very old template or CMS that does not support modern accessibility practices.
• The site is patched with multiple third‑party widgets, overlays, and custom scripts.
• Automated tools repeatedly flag hundreds of issues across most pages, especially in navigation, forms, and components reused throughout the site.

Signs a rebuild may be quicker and safer

• Core templates (headers, footers, menus, forms) fail basic WCAG checks and are difficult to change.
• Your supplier acknowledges that fixing issues individually would be costly and time‑consuming.
• You need to meet NHS or ICS-wide digital standards that your current platform cannot support. What to aim for in a rebuild

Accessible design system or component library

• Use or adapt established, tested patterns such as:

  • NHS design system components where appropriate.
  • Patterns that already meet WCAG 2.2 AA and support keyboard navigation and screen readers. Strong foundation

• Semantic HTML structure (proper headings, landmarks, lists).

• Built-in keyboard support for all components.

• Forms with labels, instructions, and accessible error handling from day one.

Governance and training

• Clear content guidelines for staff and practice teams.
• Training for those who add or update content so they understand headings, alt text, and plain language.
• Agreed processes for testing and sign-off when new sections or tools are added.

A rebuild can feel like a large step, but for many practices it becomes the quickest route to a site that is safer, easier to maintain, and better aligned with NHS digital accessibility standards.

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Key Takeaways and Next Steps

Key Takeaways

• You can run a meaningful accessibility spot-check today on your homepage without being a technical expert.
• Focus first on:
  • Contrast: text must be readable at a glance.
  • Keyboard: you must be able to see where you are when tabbing.
  • Alt text: key images must be described meaningfully.
  • Headings: H1 and H2s should form a logical, clear structure.
  • If any of these basic checks fail, your site is at greater risk of excluding patients and breaching accessibility regulations.
  • Overlays are not a substitute for fixing core templates, code, and content and can create a false sense of compliance.
  • Small content and design changes – clearer headings, meaningful links, alt text, and plainer language – can have a huge impact on usability and safety.
  • Forms and menus are where serious barriers often hide; prioritise them once your homepage passes basic checks.
  • Regular monthly checks and a clear action log help make accessibility part of business as usual and support your accessibility statement.
  • In some cases, a rebuild using accessible components is faster and more sustainable than endless patching.

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Conclusion and Practical Next Steps for Your Practice

To turn this into action in your GP practice or healthcare organisation, you can:

Run today

• Install WAVE or axe and run them on your homepage.

• Perform the 5‑step manual spot-check.

• Decide whether your homepage is a pass or fail based on the basic criteria. Within the next month

• Share findings with your website supplier or IT team and agree quick wins (contrast fixes, visible focus, alt text on key images, heading structure).

• Identify one priority user journey (for example, booking appointments) and test it for keyboard access, clarity of content, and error handling.

• Update your internal content guidelines to cover alt text, headings, and plain language.

Over the next 3–6 months

• Embed a monthly accessibility check into your digital governance or practice meetings.
• Review and update your accessibility statement to accurately describe issues and planned improvements.
• If recurring, systemic issues are identified across templates and components, explore whether a rebuild on an accessible design system would be more efficient than piecemeal fixes.

By taking ownership of these simple checks and building them into routine practice, you help ensure your digital services are safer, fairer, and more usable for every patient who relies on your website to access care.