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1. 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.
2. 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 well-being of people with learning disabilities.
3. 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 use health services better by understanding what their local GP service can provide for them and assist them in learning how to use it.
3.1 Why learning disabilities health checks are needed:
- 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.
4. Effectiveness of health checks
Studies have consistently demonstrated that health checks are effective in identifying unmet needs in people with learning disabilities.
- 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
5. 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
5.1 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.
- 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.
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 as 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.
7. Further resources
7.1 Guidance on Annual Health Checks:
- National Electronic Health Check template offers GPs a systematic approach to the Health Check which is code based, drawing on the existing patient record
- Royal College of General Practitioners has a step by step toolkit for annual health checks for people with learning disabilities
- Leeds and York Partnership NHS Foundation Trust has a range of resources on annual health checks
- Dignity in health care for people with learning disabilities guidance from the Royal College of Nursing
- Health checks for people with learning disabilities: including young people aged 14 and over, and producing health action plans
- Reasonable adjustments for people with learning disabilities - implications for commissioners and providers of healthcare
- Annual Health Check audit tool is designed to be used locally to help people evaluate the quality of current practice with regard to providing annual health checks for adults with learning disabilities, and to identify ways in which current practice could be improved. An easy read version is also available.
- Improving the Uptake of Health Checks for Adults with Learning Disabilities. Evidence into practice report no.6
- Mencap have webpages with information and guides about annual health checks
- Steps for primary care staff to complete learning disability checks
- Learning disability health checks, a training video for health professionals
7.2 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:
- About having a health check is an easy read leaflet with information about what should be included in an annual health check
- Easyhealth has a range of leaflets about health checks.
- Pre-health check questionnaire
- Health Action Profile and Plan
- My Health Book (including health action plan summary)
- Health Check Action Plan letter
- Health Action Plan