Support for those with learning disabilities

Continuing to support people with a learning disability

Delivering proactive health checks for people with a learning disability continues to be an important activity to promote the health of this group of patients. 

Healthcare professionals should discuss with the patient (if considered to have mental capacity), their carer or their advocate the most suitable and safe way to conduct a health check. Where this can be delivered safely on a face to face basis this should continue. Where this is not possible, or where the patient has other medical conditions which require them to shield or socially isolate, the review could be conducted remotely with as much of the physical review completed as is practicable in these circumstances.

Practices should use their clinical judgement and knowledge of the patient, together with the advice of family or other carers, in determining whether they would be able to participate in a remote review. Reasonable adjustments should be made to accommodate the needs of patients and carers as well as considering the capacity and capability of the GP practice whilst working in different ways. Where practices can demonstrate that they are taking an individual approach to health check delivery and are completing as much of the prescribed elements as practicable then they will be eligible for payment under the DES during 2020/21.

The delivery of care to this group of patients is further supported this year through the amended QOF Quality Improvement requirements and an additional incentive for health check coverage available to the Primary Care Network through the Investment and Impact Fund.

Improving identification of people with a learning disability

The NHS Long Term Plan commits to improve uptake of the existing annual health check in primary care for people aged over 14 years with a learning disability, so that at least 75% of those eligible have a learning disability health check each year.

There is also a need to increase the number of people receiving the annual seasonal flu vaccination, given the level of avoidable mortality associated with respiratory problems.

In 2017/18, only 44.6% of patients with a learning disability received a flu vaccination and only 55.1% of patients with a learning disability received an annual learning disability health check.

In June 2019, NHS England and NHS Improvement announced a series of measures to improve coverage of annual health checks and flu vaccination for people with a learning disability. One of the commitments was to improve the quality of registers for people with a learning disability.

Please download the below guidance document which includes a learning disability identification check-list that your practice can use.

Learning from deaths of people with a learning disability (LeDeR) review of COVID pandemic deaths

The University of Bristol report looking at the deaths of 200 people with a learning disability who died between 2 March and 9 June 2020 has been published.

NHS England and NHS Improvement have also published a response to that report in “Action from learning response to learning from deaths of people with a learning disability (LeDeR) review of COVID pandemic deaths”.

We are asking that all GP practices:

• Increase the uptake of annual health checks. GPs can use this information to assess whether a person with a learning disability is high, moderate or low risk so that annual health checks can be prioritised for people most in need. (Please note different tools are also available).
• Review the Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions for people with a learning disability registered with their practice to make sure they are appropriate for each person. Supporting guidance can be found in the quality and outcomes framework published in September 2020.
• Consider all of the health issues each person on their learning disability register has and determine whether any of their registered population with a learning disability is at a higher risk of serious illness from coronavirus so that they can be advised to take extra precautions to stay safe.
• Be aware of diagnostic overshadowing and that the signs that someone with a learning disability displays when they become unwell might be different to someone without a learning disability.
• Make sure that the right reasonable adjustments are made for people with a learning disability.

NHSE has also produced some useful guidance and resources.

Flu vaccinations

Several studies, including numbers emerging from the current Learning Disabilities Mortality Review (LeDeR) Programme have shown that respiratory problems are a major cause of death of people with learning disabilities. Despite the fact that from 2014 people with learning disabilities were eligible to have a free flu vaccination there has not been an appreciable rise in the numbers receiving this.

What GP surgeries can do

1. GP surgeries should give a clear message that people with learning disabilities, their family carers and paid supporters are entitled to a free flu vaccination.
2. People on the learning disability register should have it recorded in their notes that they “need a flu immunisation” - there is a specific Read code for this.
3. Talk to people at their annual health check about why it is important that they have a flu vaccination.
4. Put reasonable adjustments in place to help people with learning disabilities have flu injections.
5. The person seeing the patient may need to assess the patient’s capacity to decide to have the flu injection. If they do not have capacity for this decision, then this should not be a barrier to the flu injection being given; there would need to be a decision taken by the health professional that this is in their best interests.
6. Consider use of the nasal spray flu vaccine as a reasonable adjustment.

More information can be accessed here.

Resources

What to expect from your learning disability healthcheck video resource

GP practices in the Canvey Primary Care Network are carrying out home visits for some of their LD health checks.

In this video, Emergency Care Practitioner Vicky and Advanced Nurse Practitioner Liz explain what to expect from your health check, including the Personal Protective Equipment (PPE) that will be worn.

Importance of flu vaccinations for people with a learning disability

Community pharmacy teams are being asked to ensure people with a learning disability (and autistic people in an at-risk group) receive their flu vaccinations as a priority cohort alongside people over 65 and pregnant women. 

Particular attention is being paid this year to making sure that everyone with a learning disability who requests their free flu vaccination within a community pharmacy setting receives one. New easy read resources have been produced to help with communications.