The Annual Health Check is to ensure that the person with learning disabilities has aspects of their health checked and recorded by their GP Practice. It should also allow them to identify anything that is worrying them.
As a minimum, the health check should include:
- a collaborative review with the patient and carer (where applicable) of physical and mental health with referral through the usual practice routes if health problems are identified, including:
- physical examination, *BMI, waist, BP, ears, feet
- chronic illness and systems enquiry
- health promotion
- check and prompt of participation in age-related screening programmes e.g. cancer
- behaviour and mental health
- specific syndrome check e.g. Down's Syndrome, Rett Syndrome etc.
- a check on the accuracy and appropriateness of prescribed medications
- a review of whether vaccinations and immunisations are up to date, for instance seasonal influenza
- a review of coordination arrangements with secondary care, recording likely reasonable adjustments should secondary care be needed e.g. longer appointments required, need for easy read information or carer accommodation etc.
- a review of transition arrangements where appropriate for younger people, and those changing accommodation or care provider.
- a review of communication needs, particularly how the person might communicate pain or distress
- support for the patient to manage their own health and make decisions about their health and healthcare, including through providing information in a format they can understand and any support they may need to communicate.
- a review of family carer needs should also be included.
Discuss any forthcoming screening invitations with patient and provide easy read information if required.
*NB: BMI and waist measurements have been noted as being of specific concern in the Learning Disability population of Derbyshire. Health Action Plans should address this by referral to Healthy Lifestyles services, or by health promotion in the practice setting. The Healthy Lifestyle Service in Derby and Derbyshire has agreed that wellbeing workers will see all people with a learning disability, so please refer the individuals as part of the health check to the Derby Livewell Service or Derbyshire Live Life Better Service.
All GP practices across Derbyshire are being provided with 12-Month Challenge booklets (widget symbols) in order to prompt people with learning disabilities to lead a healthier lifestyle. The 12-Month Challenge booklet is also available in photo symbols.
Local screening issues
Many people with learning disability miss out on appropriate screening, please use the opportunity to discuss Abdominal Aortic Aneurism, Breast, Cervical, Bowel and Diabetic Retinopathy screening (some useful guides are available to view below). The Learning Disability Community Team may be able to help people who have a anxiety about screening appointments.
Stopping over-medication of people with a learning disability - STOMP LD
There is a national drive to stop the over-medication of people with learning disabilities. The Annual Health check is an opportunity to review the medication, particularly psychotropic medication. Tools are available to help you do this from the websites highlighted below. You could also monitor neuroleptic side effects using our neuroleptic medication workbook.
The following organisations have a range of easy-read leaflets and tools on topics such as the brain, stress, mental health, epilepsy, depression, dementia, behaviour problems, anxiety, alcohol and abuse:
What can help?
We suggest that Easy Read Guide to having a Health Check at your GP Surgery is used to help the patient understand what is happening at the health check. They could use the Your Health Check - Male or Your Health Check - Female documents to choose the order of what happens, and also if the clinician adds information to the template, help the person keep a record of the appointment.
Where problems or concerns are identified, practices will be expected to address them as appropriate through the usual practice routes or via specialist referral if required. More information can be found in The Royal College of General Practitioners - Good Practice Guidance.
Inclusion in other Enhanced Services
Practices also participating in other enhanced services may find that the annual learning disability health check also provides an ideal opportunity to check for other concerns:
- ‘Facilitating timely diagnosis and post-diagnostic support for people with dementia', possible memory concerns and assessment for dementia for attending patients, where clinically appropriate
- ‘Avoiding unplanned admissions: proactive case finding and care review for vulnerable people' consider case management and planning arrangements
- Personalised advanced care planning.
Some of your patients may have difficulty with blood tests. The Public Health England guide 'blood tests for people with learning disabilities' may help.
QUALITY MONITORING 2022
The Strategic Health Facilitation Team is offering practices the chance to receive a free quality check, including recommendations on how to improve the quality of annual health checks. If you would like to receive aa quality check get in touch with your link facilitator today.
Image courtesy of Photosymbols: www.photosymbols.com