Annual health check for people with learning disabilities Care Pathway

Review in progress

Disclaimer: The guidance contains helpful primary care information for management of referrals and up to date referral criteria. These guidelines are locality specific to best reflect local services. This guidance does not override or replace the individual responsibility of healthcare and social care professionals involved in the delivery of care to make informed professional judgements appropriate to the circumstances of the individual.

Scope

This guidance refers to:

  • All patients aged 14 and over with learning disabilities.
  • The provision of annual health checks for people with learning disabilities, recognising that whilst they have poorer physical and mental health than other people this is not inevitable. These health inequalities can be avoided by the provision of annual health checks to:
    • Identify developing health problems early
    • Check that current treatments are appropriate and working
    • Familiarize people with learning disabilities with their GP and the surgery so they are better able to offer support when the need arises.

This guidance does not cover:

  • Individual who do not have learning disabilities
  • Young people under 14 with learning disablities

Assessment

Preparation for Health Check

Actions required prior to a health check taking place:

  • Send person with learning disabilities and/or their carer an invite to their yearly health check
  • Try to offer the person with learning disabilities a named administrator to contact to book or change the appointment.
  • Offer a choice of appointments to try to ensure any main carers can attend at the same time and avoid booking the person at a time the surgery is likely to be busy and running late such as at the end of surgeries.
  • Arrange blood tests at least 1 week before the annual health check so the results are available for the health check.
  • Contact the person with a learning disability and their carer 24 hours before hand by phone and request a urine sample.
  • Provide a pre heatlh check questionire to help prepare the patient and carer for their health check appointment, reduce anxiety and improve effectiveness of appointment.

Carrying out Health Check

As a minimum the health check should include:

  • A collaborative review with the patient and carer (where applicable) of physical and mental health including: health promotion, chronic illness and symptoms enquiry; physical examination; epilepsy, dysphagia, behaviour and mental health and specific syndrome check
  • Accuracy and appropriateness of prescribed medication checked - See Stopping Over-medication of People with a Learning Disability, Autism or Both (STOMP)
  • A review of co-ordination arrangements with secondary care
  • A review of transition arrangements (where appropriate).
  • A review of communication needs
  • A review of family and carer needs
  • Support for the patient to manage their own health and make decisions about the health and healthcare
Examination
  • Consider if the person shows signs of non-accidental injury, abuse, neglect of self injury
  • Consider screeing history and appropiate immunisaitons such as seasonal flu
  • Teeth
    • Ask to see the person oral cavity and check if the person regularly cleans their teeth and have regular dental checks.
    • Determine whether the person needs to be referred to a community dentist.
  • If the person with a learning disability has a specific syndrome then there may be additional specific clinical checks
  • Obesity
    • insulin resistance and diabetes mellitus
    • Hypertriglyceridemia
    • decreased levels of high-density lipoprotein cholesterol (HDL)
    • increased levels of low-density lipoprotein cholesterol (LDL)
    • gallbladder disease
  • Mobility - if the person is not fully mobile then assess:
    • Does their head turn mainly to one side?
    • Does their body tend to falls sideways, backwards or forwards?
    • Do their knees tend to fall to one side, or inwards, or outwards?
    • Are there any parts of the patient's body which are already asymmetric or distorted?
    • If the person used a specialist seating system ask if they are also supported at night
    • If the person uses night positioning is there a thorough safety planning process covering aspects such as – reflux, temperature control (many people get too hot in sleep systems so increasing the risk of seizure activity), aspiration, pressure areas, ability to breathe if the position is very different to the habitual position, circulation, feeding and continence issues
  • Spine
    • Spinal scoliosis is common in patients with profound and multiple learning disabilities e,g Retts and Angelman sydromes. Check any wheel chair or device fits the person and there are no signs of pressure sores. Ask about proactive postural care particularly for when the person sleeps.
  • Abdomen - Conduct an examination of abdomen to check for:
    • intra-abdominal masses particularly faeces from constipation, occult malignancy or a distended balder from prostatism
    • any signs of urinary infection and skin irritation
  • Chronic illness
    • Check if the person with LD has any co-morbidities and that they are on the 'care pathway' for that condition. This is particularly important for epilepsy.
  • Respiratory
    • A normal respiratory examination should be carried out with recording oxygen saturation and peak flow.
  • Cardiovascular
    • Assessment should try to focus on normal CVS risk factors for the general population and reviewing any new symptoms and any previous correction of congenital heart disease.

Following Health Check

  • ensure patient review and recall is in place
  • ensure patient and carer understand any specific actions and referrals required
  • liaise with family and/or CLDT, as appropriate
  • audit health checks and seek feedback from users and carers

Red Flags

Seek immediate or urgent specialist advice/treatment if:

  • Any examination of investigation indicates the need for urgent assessment and ongoing treatment

Referral

Referral Criteria

  • If health check indicates the need for specialist referral the appropriate care pathway should be followed taking into consideration the need to provide accessible information and addtional support as required

Supporting Information

Shared Decision Making

  • Patients have a right to make decisions about their care and should be fully informed about the options they face. They should be provided with reliable evidence-based information on the likely benefits and harms of interventions or actions, including any uncertainties and risks, eliciting their preferences and supporting implementation. For people with learning disabilities this may mean the involvement of health care professionals and family members, the provision of easy read information and the breaking down of information so it is more easily understood. For further information about SDM and people with learning disabilities click here

Patient information/Public Health/Self Care

Evidence/Supporting Information

Assurance & Governance

  • This guidance was developed on: 03.2017
  • This guidance was ratified by: The OSCAR Assurance Group
  • Date ratified: 05.2017
  • Publication Date: 05.2017
  • Review Date: 03.2019
  • Ref No: LD1 - 03.2017
Any feedback or suggestions to improve this guidance should be sent to: oscaradmin@this.nhs.uk
Only the electronic version is maintained, once printed this is no longer a controlled document

 

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