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Information for Primary Care staff

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LD useful info web.jpgWhat is a learning disability?

A learning disability affects the way a person learns new things throughout their life.

It is estimated that 1.5-2 million people in the UK have a learning disability. 

People with a learning disability can have difficulty:

  • understanding new or complex information (have impaired cognition)   
  • learning new skills    
  • have difficulty in doing things independently (have impaired social and adaptive functioning)   

The learning disability diagnosis is usually given by an Educational or Clinical Psychologist. However, this inclusion tool may help you identify whether someone may or may not have a learning disability.

Please note a few examples of conditions and diagnoses that would NOT classify as Learning Disability.

The Wessex Local Medical Committee is producing Learning Disability specific podcasts. Each podcast is focusing on a different topic.

Information to follow 

In 2020/21 GPs are asked to complete a QOF Quality Improvement plan (updated in September 2020) for their Learning Disability Health Checks. The target is to achieve 67%. 

Please invite all patients on your Learning Disability Register aged 14 and over for their Learning Disability Annual Health Check.

If you'd like to improve your uptake of Annual Health Checks, please contact your local Strategic Health Facilitator who can help you. 

They can also provide practices with Learning Disability / Annual Health Check training, support with Learning Disability register, and advice on reasonable adjustments, easy read information, local services and non-attenders.   

Hampshire Southampton Support Pack for GP Practices re-starting Annual Learning Disability Health Checks Oct 2020 

HCC Well-Being Guide - includes signposting information for weight loss, support with bereavement & tips for mental well-being.

Information on our Community Learning Disability Teams

If you are not sure which Community Learning Disability Team to refer too - use our finder tool

A report produced  by Public Health England (2020) looking at statistical data relating to the mortality of people with learning disabilities from covid-19, identified the death rate is up to 6 times higher than in comparison to the general population.  Research identified all age groups of people with learning disabilities were affected in particular 55-64 year olds and data also highlighted mortality amongst adults with learning disabilities aged 18-34 years is 30 times higher in comparison to adults without learning disabilities. Data also found slightly more males died from covid-19 and individuals living in residential care settings.

People with learning disabilities have greater health needs than the general population with respiratory disease being the leading cause of death. Due to communication difficulties sometimes people with learning disabilities find it hard to express symptoms they may be experiencing or recognise when they are becoming ill. These factors make it even more important to raise the awareness of the covid-19 vaccine to people with learning disabilities and their carers.  

Adults with Down’s Syndrome are now also included on the Clinically Extremely Vulnerable list.

The following recommendations can help the successful delivery of the covid-19 vaccine to people with learning disabilities:

  • Send covid vaccine easy read resources to patients with learning disabilities
  • Display easy read resources in your GP practice waiting areas
  • Identify and implement reasonable adjustments for each individual patient when their appointment is made. This could include longer appointment, first appointment to reduce waiting times, home visit or use of emla cream
  • If the patient is needle phobic, complete desensitisation work

Please revisit Mental Capacity Act guidance to ensure the 5 key principles of the act are adhered to when assessing patients capacity to consent to the covid-19 vaccine.

More resources can be found on our Health Information page  

Research has found the leading cause of death in people with learning disabilities is respiratory disease, which accounts to 40% of deaths (Learning Disability Mortality Review 2019).  Patients under the Chronic Neurological Conditions at risk group (which includes people with learning disabilities) are also at an increased risk of mortality from influenza. In light of this people with learning disabilities have been entitled to have the free influenza vaccine since 2014. 

People with learning disabilities aged 18+ that are not able to receive flu injection due to, for example, a needle phobia, should be offered nasal flu vaccine prescribed off licence. To find out further information please visit PHE website. In addition, a list of flu vaccinations marketed for 2020/21 is available here, this includes egg free vaccine.

0. Get your free Flu vaccine poster PHE (Easy Read) 

1. Flu vaccine Consent Form (Easy Read) NEW - Sept 22

2. Covid Autumn booster and Flu vaccination Consent form (Easy Read) NEW - Sept 22

3. Covid Autum booster and Flu vaccination Best Interest Form (Easy Read) NEW - Sept 22

4. Flu vaccine Top Tips slide (Reasonable adjustments, legislation & resources) 

5. Flu Jab information sheet - June 2020 (Easy Read)

6. Flu jab letter for GP use - September 2020 (Easy Read) 

7. Flu - Social Story - check out Brian! (Easy Read)

8. Flu Jab Poster 2018 (Easy Read

9. Nasal spray FLU vaccine given at a GP Practice or Nasal spray FLU vaccine give at home (Easy Read)

10. Having a flu jab (Books Beyond Words)

Having an up to date and accurate Learning Disability Register is a essential.

QOF requires the practice to create and maintain ‘a register of patients with LD’ with no ‘age of patient’ parameters set. However, the LD Health Check Scheme (DES) states ‘a requirement that the contractor (practice) set(s) up and agrees with the Board (NHS England or the CCG) a “health check learning disabilities” register for the purpose of identifying those of its registered patients aged 14 years or over with learning disabilities who are to be invited for an annual health check under the arrangement (the DES). These patients should also be offered the free influenza vaccine. 

Coding is key to ensuring that people with learning disabilities are not only included on the QOF Learning Disability Register but your practices Learning Disability Register as well. Every patient who has a learning disability must have the “On the Learning Disability Register” code to ensure patients are on both Learning Disability registers. If patients are coded with a particular syndrome, for example, Down’s syndrome these codes will not pull the patient onto your practices Learning Disability register. In this example the patient should have the Down’s syndrome code and On the Learning Disability Register code.

The codes for On the Learning Disability Register are:

  • System One/ TPP code: XaKYb
  • EMIS code: 918e
  • SNOMED: 416075005

Tip: When new patients register check they have been coded correctly and should be on the Learning Disability register.  To maintain an accurate and up to date register review it regularly.

Identifying whether someone meets the eligibility of having a learning disability is not just reliant on a cognitive assessment. Often people with learning disabilities have never had a cognitive assessment.  It is important, when establishing whether someone has a learning disability or not to look at the patient’s general day to day functioning, employment, schooling and so forth. The Learning Disability inclusion Tool (Leeds CCG) helps you to gather this information and reach a decision.

NHS England & NHS Improvement also published a guidance on Improving identification of people with a learning disability so please review this as necessary.

Contact your local Community Learning Disability Team if you are unsure if a patient does or does not have a learning disability.

Please note Community Learning Disability Teams are not commissioned to assess patient’s cognitive ability unless the patient has an adapted clinical health need(s) the service is commissioned to provide.

When submitting your LD register size on CQRS please try to ensure you are submitting the total number of eligible patients aged 14 years+. 

Find out Health related information on topics such as 

- Annual Health Checks

- Blood

- Cancer Screening

- Coronavirus

- Dental

- Diabetes

- End of Life

- Epilepsy

- Flu

- Health and Well being and Health Action Plans

- Mental Health

- Poo and wee

- Sepsis

- Skin and Skin Conditions

- STOMP (Stopping the over-medication of people with a learning disabiity, autism or both) 

 

The Learning Disability Friendly GP Practice Project is an award scheme for GP surgeries within Hampshire and Southampton. The Strategic Health Facilitation Team will work with identified Primary Care staff, including Learning Disability Champions on reviewing the service and support offered to people with a Learning Disability with a view to support each surgery to follow best practice.

Find out more about this project

 

Information on the Mental Capacity Act

Mental Capacity Act 2005 (Easy Read) 

Reasonable adjustments are a statutory duty under the Equality Act 2010, which says that “health and social care providers must make reasonable adjustments to remove any barriers – physical or otherwise – that could make it difficult for disabled people to use their services or prevent them from using them altogether.

NHS Digital and NHS England have built the flag in the NHS Spine to enable health and care professionals to record, share and view details of reasonable adjustments across the NHS, wherever the person is treated. Having been successfully piloted, the capability is now in further final development, and will be available for wider use from the end of 2020.

In the meantime, GP practices should continue to record reasonable adjustments in patient records as "usual". 

This Reasonable adjustment form can be used to support this work.

Stopping the over-medication for people with a learning disability, autism or both (STOMP)

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STOMP stands for stopping over medication of adults with a learning disability, autism or both with psychotropic medicines. It is a national project involving many different organisations which are helping to stop the over use of these medicines. 

STOMP aims to:
  • Improve the quality of life of adults with a learning disability or autism
  • Make sure people only receive psychotropic medication for the right reasons and in the right amount
  • Improve understanding of psychotropic medicines and when they should or should not be given
  • Improve understanding of alternatives to medication
  • Make sure that people with a learning disability, autism or both are involved in decisions about their health and treatment.

Psychotropic medication should only be prescribed for managing behaviour which challenges when it is used in combination with psychology or other therapies.

Psychotropic medication is often prescribed for people with a learning disability, autism or both with an acceptable diagnosis of a serious mental illness such as psychosis or bipolar disorder. STOMP also aims to ensure that medications used in this way are reviewed and monitored appropriately. 

Find out more about STOMP

If a patient is prescribed Psychotropic medication for behaviours which challenge and you wish to discuss this with a Consultant Psychiatrist please contact your local Community Learning Disability Health Team for advice.

Useful documents to download

Stopping Over-Medication of People with a Learning Disability, Autism or Both (vodg.org.uk)

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Find out more about the Strategic Health Faciliatators 

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