Annual health checks and people with learning disabilities

Published 8 May 2016

Annual learning disability health checks

NHS GPs in England can be paid to undertake annual health checks for people registered with them who have learning disabilities and meet the eligibility criteria.

They must be:

  • aged 14 and over
  • on the practice learning disability health checks register

The scheme also requires practices to undertake relevant training and to use a health check protocol agreed with their local commissioning organisation.

Evidence to support learning disability health checks

Evidence suggests that providing health checks to people with learning disabilities in primary care is effective in identifying previously unrecognised health needs, including those associated with life-threatening illnesses.

Public Health England’s Learning Disabilities Observatory has published a systematic review of evidence concerning the impact of health checks on the health and wellbeing of people with learning disabilities.

NHS health check and learning disability health checks

Learning disability annual health checks are different from the wider NHS health check scheme. The learning disabilities health checks are designed to pick up a wider range of unmet health needs whereas the latter is intended to help individuals reduce their risk of heart disease, stroke, diabetes and kidney disease.

Learning disabilities health checks can help people with learning disabilities to use health services better by understanding what their local GP service can provide for them and learning how to use it.

Health checks are needed because:

  • primary care services tend to be reactive, responding to problems raised by patients
  • people with learning disabilities may be unaware of the medical implications of symptoms they experience, have difficulty communicating their symptoms or may be less likely to report them to medical staff
  • carers may not always attribute clinical symptoms to physical or mental illness
  • health checks provide a way to detect, treat and prevent new and unmet health conditions in this population.

Health checks may help provide baseline information against which changes in health status can be monitored. This is a particular problem due to the frequency of changes in paid carers supporting people with learning disabilities and the difficulties that people with learning disabilities may have in detecting and reporting longer term changes in health status.

It’s also been argued that health checks may be cost effective in detecting existing or new medical conditions and may take up less resources in other areas, such as services for challenging behaviour and mental health problems, and reduce the need for future and potentially more expensive treatment.

Effectiveness of health checks

Studies have consistently demonstrated that health checks are effective in identifying unmet needs in people with learning disabilities, for example:

  • health checks resulted in the identification of previously undetected health conditions in 51% to 94% of patients
  • the number of previously undetected or unmanaged health needs identified per patient ranged from 2.2 to 5.2
  • these conditions included serious and life-threatening conditions such as cancer, heart disease and dementia, and minor health conditions, such as impacted ear wax
  • health checks are effective in promoting actions to address identified health needs such as vaccinations, blood tests, breast and testicular screening, dental review and vision and hearing assessment

Role of health checks in finding and treating health problems

10% to 15% of people with learning disabilities have challenging behaviours which may result from physical health problems.

The small amount of available evidence shows that:

  • health checks can identify health problems in a significant proportion of people who display challenging behaviours

  • treating these health problems can reduce or stop challenging behaviour

Impact of health checks in treating challenging behaviours

Of 56 adults with learning disabilities referred to a service for behaviour management, it was judged that 13 of these people’s challenging behaviour might be due to a medical cause. When these 13 people were given a health screen, 10 (77%) of them had health conditions potentially related to their challenging behaviours. Of these, 8 out of 10 people showed an improvement in behaviour once medical problems were addressed.

Medical evaluation of 1,135 people with learning disabilities referred to a clinic for challenging behaviour found that 75% of the sample had one or more undiagnosed or undertreated health problems.

These included:

  • epilepsy (46% of the sample)
  • hypothyroidism (13%)
  • gastro-oesophageal reflux (10%)
  • severe closed head trauma (9%)
  • chronic pain (9%), and more rare but serious conditions such as cancer

In 43 people (4%) seizures were identified as the sole cause of their challenging behaviour. In many cases, the person’s challenging behaviour stopped once their health condition was treated.

There are serious limitations in the evidence base and more work is needed to establish the effectiveness of health checks in identifying and treating health issues in people who display challenging behaviour, and in evaluating their impact upon behaviour.


The learning disabilities annual health check is a reasonable adjustment that can be effective in detecting unmet health needs and leads to the treatment of health conditions which may be serious or life-threatening. The Confidential inquiry into the premature deaths of people with learning disabilities (CIPOLD) recommends a standardisation of annual health checks and a clear pathway between annual health checks and health action plans.

Reducing health inequalities through health checks should be a priority for commissioners and providers because reducing health inequalities is a requirement for all public sector organisations. It’s important that commissioners, providers, family carers and people with learning disabilities understand the importance of annual health checks and that support systems are put in place to improve the uptake and quality of annual health checks.

Further resources

Guidance on annual health checks:

Accessible resources

There are various easy-read resources that can be used to help prepare someone for a health check and to document actions that arise from it:

Health check video guides

Having your health check: a video for people with a learning disability

Learning disability health checks, Lambeth Clinical Commissioning Group

Annual Health Check consultation

Learning disability annual health check, Gateshead Clinical Commissioning Group

Annual Health Check

Annual Health Check consultation

A guide to your LD health check - for adults with learning disabilities

A guide to your learning disability health check - for adults with learning disabilities

How to get a health check up for people with learning disabilities

How to get a health check up for people with learning disabilities