LearningdisabilityLES from1April2009 09 10

							                               New General Medical Services Contract

                     Specification for the Provision of an Enhanced Service

                        SERVICE                                        REFERENCE
    People With Learning Disabilities                                    LES 50
                                                                        April 2009

Introduction
This enhanced service is designed to improve equality of access to mainstream health services for
people with learning disabilities by offering a system of regular, comprehensive and individualised
health checks in primary care. The scheme is supported by a Health Facilitator able to provide training
and support to practices wishing to provide this LES.

This service is funded on a non-recurrent basis for the year 2009/10. The PCT reserves the right to
amend or withdraw this enhanced service.

Background
This service is designed in line with national guidance: in 2001, the Valuing People White Paper1
required the introduction of Health Action Plans for all people with learning disabilities and the
Choosing Health White Paper2 included a target to introduce health checks for disabled people to
reduce health inequalities and improve ill health. The Our Health, Our Care , Our Say3 White Paper in
2006 reaffirmed the need for regular, comprehensive health checks for people with learning disabilities
and placed a stronger emphasis on health and well being, prevention of ill health and early
intervention.

The Valuing People White Paper uses the following definition of learning disability:

Learning disability includes the presence of:
   • A significantly reduced ability to understand new or complex information, to learn new skills
       (impaired intelligence)
   • A reduced ability to cope independently (impaired social functioning)
   • Which started before adulthood, with a lasting effect on development.

It is generally accepted that people with learning disabilities have poorer health than the rest of the
population. The reasons for this include:
      A higher prevalence of certain conditions – including epilepsy, dementia, schizophrenia, thyroid
        problems, osteoporosis, sight and hearing problems, poor oral hygiene, being over or under
        weight and mental health problems.



1                                                                 st
  Valuing People: A new strategy for learning disabilities for the 21 Century (DH, 2001)
2
  Choosing Health; Making healthier choice easier (DH, 2004)
3
  Our health, Our Care, Our Say: a new direction for community services (DH, 2006)

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      An increased risk of early death – people with learning disabilities are much more likely to die
       before the age of 50 and life expectancy is lowest for those with the greatest support needs.
      Being part of a disadvantaged group of society - people with learning disabilities have less
       opportunities to prosper, often live on benefits and have limited choices
      Having unhealthy lifestyles – many people with learning disabilities are dependant on others
       for access to activities and therefore can have a sedentary lifestyle .They are also less likely to
       have access to health promotion material which is accessible to them.

There are additional factors that mean people with a learning disability have poor access to the health
care they need, these include:
    Identifying their own health needs is a big challenge for many people with learning disabilities:
       pro active strategies are required to help them to access health care.
    Families and paid carers have an important role in helping many people with learning
       disabilities to access health care. However they may not be aware of what constitutes good
       health; they may have difficulty in recognising mental health problems and noticing gradual
       changes in health.

Aims
      To ensure all patients with a learning disability aged 18 and over are identified and included in
       the practice learning disability register.

      To ensure that all adults with learning disabilities in Brighton and Hove are offered the
       opportunity to receive a regular, comprehensive health assessment and a resulting health
       action plan, and are provided with appropriate treatment and follow up.

      To ensure individuals with learning disabilities have equality of access to primary care health
       team professionals and that they are fully involved in their own care and in planning and
       reviewing services.

      To promote better health outcomes and better involvement in health care by improving access
       to health promotion advice and programmes.

      To reduce the need for hospitalisation by providing better and more coordinated care.

      To improve support for and understanding of people with learning disabilities and their carers.

Service Outline
Key Elements to Service

      Develop and maintain a register of patients aged 18 and over with a learning disability
      Develop practice systems to deliver service i.e. recall systems, familiarise staff with health
       check template and health action plan etc
      Complete Practice training session from Health Facilitator
      Invite eligible patients for annual health check
      Write health action plan as outcome of health check for each patient
      Repeat annually.




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Preparation

      Identify a practice lead, a GP or senior nurse, to lead the development of this enhanced
       service within the practice and liaise with the community learning disability team (CLDT).

      Develop and maintain a learning disability register of patients aged 18 years and over. QOF
       indicator LD 1 rewards practices for keeping a register of patients with a learning disability.
       This should be compiled taking into account those persons known to the CLDT. Practices
       should use the Leeds read code searches to develop the register (this document is provided by
       the Health Facilitator). It is recommended that practices follow these recommendations for read
       code use once people have been identified as needing to be included on the register: use
       generic ‘on learning disability register’ code for all patients on the register; use syndrome
       specific code e.g. ‘downs syndrome’ in addition for each patient, if appropriate (i.e. the patient
       has a specific diagnosis and a read code exists).The service is directed at those with a
       diagnosis of mild, moderate or severe learning disability and does not include those individuals
       with other needs, such as autistic spectrum disorders or Asperger syndrome, who do not have
       a learning disability.

      Practice team to undertake training around the needs of people with learning disabilities. All
       members of the team should be encouraged to attend an in house training session which will
       be facilitated by the CLDT project worker.

Health checks

A letter of invitation for a health check, together with an explanation, should be sent to each patient on
the register. This should give an extended appointment time or choice of times or invite the patient or
their supporter to call to make an appointment. People with learning disabilities may need longer
appointments with the primary care team because of communication or access problems.

      Patients attending for a health check should be helped to identify a health facilitator to support
       them during the process.

      Before the health check is undertaken, patient ability to consent should be determined
       (consider risk and “best interests” if consent not given). If consent is refused, this should be
       discussed with the patient and their carer/supporter and they should be invited to attend again
       at a future date.

      The health assessment will be carried out by a primary care professional using the Learning
       Disability Health Assessment form attached together with the inclusion of any additional health
       checks deemed necessary by the practitioner in relation to the individual’s needs (i.e. health
       issues relating to a syndrome). The report needs to be integrated into the patient’s medical
       records.

      Each assessment completed will result in an individual Health Action Plan produced by the
       practitioner. This will be a standard template (attached) a copy of which will be held in the
       individual’s records and a copy of which will be given to the person with learning disabilities.
       Efforts will be made by the practitioner and carer (if present) to ensure understanding of the
       content where possible.

      Individuals with learning disabilities may present with completed self assessment summaries
       which have been developed to encourage participation and ‘ownership’ over their own health:
       these should be used to inform the assessment process by the practitioner.
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       The person with learning disability may need to be visited in their own home if attending an
        appointment at the surgery will result in excessive anxiety.

       The surgery will provide structured follow up as required. This may include referral to national
        or local peer support groups, for example, www.fragilex.org.uk for people with fragile x
        syndrome.

       The practice should continue to be involved in the health care needs of the individual,
        communicating to and receiving feedback from family carers, local CLDT members and other
        services as appropriate.

       Annual reviews should be incorporated within the practice recall system. Reviews should
        include an updated health check and review of previously agreed actions.

       The practice will conduct an annual review of this enhanced service and any protocols and
        procedures which relate to it.

       Ongoing learning by the practice and continued professional development and up dating are
        essential to maintaining good professional practice.

Eligibility

All GP practices are eligible to provide this service to their own patients but will be required to:
- maintain a register of patients with learning disabilities;
- identify a clinical practice lead; and
- complete an in house training session. It is expected that this will be attended by the majority of
clinicians who will provide the service and will include GP, nursing and practice staff representatives.

Practices should apply using the standard enhanced services application form.

Payment

In 2009/10, each practice contracted to provide this service will receive a payment of £101.74 for each
annual health check completed.

Advance payments will be made based on an estimate of the number of health checks anticipated,
with financial reconciliation at year end.

Audit

The PCT requires each participating practice to complete an annual audit of the service.

The following associated documents can be found on the PCT’s website at:

http://www.brightonhovecitypct.nhs.uk/healthprofessionals/generalpractice/enhancedservices/
index.asp

- Learning Disability Health Assessment template
- Health Action Plan template


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Specification design and review group

Alistair Hill- PCT, Consultant in Public Health
Laura Wade- PCT, Primary Care Commissioner
Clare Mitchison- PCT, Clinical Assurance & Audit Manager
Cath Scott- Manager, Community Learning Disability Team
Natalie Winterton- Community Learning Disability Team

Date due for review

April 2010




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