Fletch's personable characterisation has helped establish friendship with many characters, notably with Lloyd Asike (Michael Obiora) and Raf di Lucca (Joe McFadden).

Fletch's main story in Casualty is his affair with senior nurse Tess Bateman (Suzanne Packer), which leads to the breakdown of his marriage to Natalie Fletcher (Claire Cage).

Fletch's first major story began in 2015 when he becomes a single father following Natalie's death and struggles financially, briefly becoming involved in criminal activity.

His next story portrays him as a protective father when his daughter, Evie Fletcher (Phoebe French), becomes involved with Andrei Tarpov (Sonny Poon Tip) and Kian Madani (Ramin Karimloo).

The character continued to be written into dramatic stories as Evie becomes sexually exploited by Fletch's new love interest, Jeni Sinclair (Debra Stephenson).

[2] Executive producer Johnathan Young expressed his joy at Walkinshaw's casting and commented, "He's brings bags of talent, a wealth of experience and a cheeky sense of humour to rival Fletch's!

While he's prepared to take orders from those younger than him and knows he has lots still to learn in terms of practical experience, he isn't afraid to talk back or question something he disagrees with.

[6] Fletch is a staff nurse at Holby City Hospital's emergency department (ED), a job which he enjoys since he likes learning new skills and meeting new people.

[15] Walkinshaw told Sue Haasler, writing for the book Holby City: Behind the Screen, that Fletch is the "glue between people" and said that he would emotionally support others as he felt it was as important as treating patients.

[15] Despite his fondness of women, Fletch is loyal towards his wife Natalie Fletcher (Claire Cage), who was originally named Keila,[2][4] and their three children, Evie, Mikey and Ella.

[28] Fletch and Tess' relationship is explored in a special episode, entitled "Mistletoe and Rum", made available to watch on BBC Red Button on 15 December 2012.

[10] The executive producer of both shows, Oliver Kent, said that Fletch and Walkinshaw had been "a wonderful asset to Casualty" and he was looking forward to him joining Holby City.

[12] Phillips told a BBC Online reporter that the crew faced multiple challenges with the episode, including making sure that the script "really held water and did justice to the story that we really want to tell.

[10] He is offered the position of the ward manager of the Acute Assessment Unit (AAU) after Raf di Lucca (Joe McFadden) complains to Colette about a lack of nurses.

[56] When asked about Fletch's upcoming storylines, Walkinshaw teased stories with Colette, Raf, Harry Tressler (Jules Knight) and Serena Campbell (Catherine Russell).

His superiors, Guy and AAU consultant Ric Griffin (Hugh Quarshie) warn Fletch not to mix his personal and professional lives in his new job.

[85] Clifford confesses how he owes money to "violent drug dealers" and he needs to repay them, before revealing that they know about Fletch and his children, placing their lives at danger.

[94] In the narrative, Fletch appears at a surprise party for senior nurse Charlie Fairhead (Derek Thompson), who is celebrating thirty years in the NHS.

[95] Walkinshaw reprises his role in Casualty again during its thirty-third series for a two-part crossover episode - "CasualtyXHolby" - with Holby City, originally broadcast in March 2019.

[122] Fletch becomes the hospital's acting chief executive officer (CEO) in April 2021, following the arrest of Max McGerry (Jo Martin) and a lack of other candidate.

[125] In an August 2017 interview with Digital Spy, series producer Kate Hall revealed that she had paired Fletch with Jac Naylor, the director of cardiothoracics, for a new storyline as she thought that they had a "palpable" connection.

[126] On the comparison, Marcel told Laura-Jayne Tyler, writing for Inside Soap, that she loved playing the Moonlighting aspect of the relationship and that Walkinshaw would be Shepherd to her Willis.

[136] In November 2018, Inside Soap reported that the show's Christmas episode would focus on Fletch and Steven's relationship after "an explosive family secret" is revealed.

[148] Dainty (Digital Spy) theorised that the characters may be paired romantically after spotting their closeness and after Ange's daughter Chloe Godard (Amy Lennox) noted their chemistry.

[151] Fletch works with Jac and Hanssen to search CCTV footage and eventually receives contact from the kidnapper, who suggests they are a protestor and warns him not to involve the police.

[163] Wragg liked the decision to portray the stories together and commented, "Showing the real struggle of two nurses sharing an illness together yet being alone in their own torture of what their futures hold is Holby at its best.

[164] Writers began the story with Essie's formal diagnosis while portraying early signs in Fletch's health, such as experiencing "worrying dizzy spells".

[173] A Holby City promotional trailer, released on 29 April 2021, included scenes of Fletch confronting consultant Kian Madani (Ramin Karimloo) after Evie and Andrei Tarpov (Sonny Poon Tip) are stabbed.

[206] The show's story team moved the focus of the final episodes away from the hospital's potential closure and instead, opted to explore the ramifications of Jac's terminal illness on those surrounding her.

[79] On Fletch, a columinst from What's on TV commented, "As ward manager of Holby's AAU, Adrian 'Fletch' Fletcher is dedicated to his job, running a tight ship at work while raising four kids as a single dad.