People with a learning disability have been shown to have poorer health and a lower life expectancy than the general population, with life expectancy gaps of 18 years in females and 14 years in males (NHS Digital, 2019), despite annual health checks that were introduced for all people with a learning disability aged over 14 years to try to tackle this inequality. Evidence suggests annual health checks are an effective way to identify previously unrecognised health needs, including those associated with life-threatening illnesses.
However, uptake of health checks has been lower than hoped. Nationally, the annual health check target for adults with learning disabilities is 75%. Statistics from 1 April 2018 to 31 March 2019, show that only 42.9% of adults with learning disabilities had completed their annual health check.
A project to Increase the number of annual health checks
A project led by Kent Community Health NHS Foundation Trust aimed to address this by increasing the number of annual health checks carried out with people with a learning disability over 12 weeks. The project team worked with six general practices across Kent.
At the start of the COVID-19 pandemic, three of the GP surgeries in the project had to cancel their adult health check clinics as they were not able to provide face-to-face appointments. However, the project team still managed to achieve an increase in checks for all six general practices collectively, from 22.3% to 48.3%, with two practices providing health checks to all of their patients with learning disabilities. The three surgeries that continued to provide the annual health check clinics during the pandemic, completed checks with 93–100% of their learning disability patients, showing what is possible with concerted effort.
Health checks are an effective way to identify previously unrecognised health needs, including those associated with life-threatening illnesses.
Behind the project were Lisa Harrington, Specialist Community Matron Learning Disabilities, Becky Hankin, Senior Community Learning Disability Nurse and Chris Hunter, Senior Community Learning Disability Nurse.
Lisa Harrington explained: ‘The project's aim was to increase the uptake and quality of annual health checks for people with a learning disability.’
‘We achieved this by working with GPs, people with a learning disability and their families and carers. We focused on increasing awareness and understanding about the benefits of the annual health check and making sure information was accessible.’
Chris Hunter added: ‘The project promoted best practice, provided specialist learning disability nursing support and advice and promoted an increased uptake of annual health checks through local links and positive experiences.’
Importance of health checks in people with a learning disability
When asked why health checks are important for people with learning disabilities, Becky Hankin commented: ‘Annual health checks prompt health education, understanding of health conditions and early detection of changes in health. They not only benefit the person with a learning disability, but we have had feedback that GPs, carers and families also feel they benefit their understanding of the person's needs and how best to support them. The annual health checks can help reduce anxieties around accessing health care for adults with learning disabilities and improve signposting to appropriate teams, not only community learning disability health teams, but also mental health and social services teams.’
Diagnostic overshadowing can occur in people with learning disabilities, where symptoms are attributed to the person's learning disabilities without checking for other causes. It is important that health checks are carried out without assuming that any new health issues are linked to the learning disability (National Institute for Health and Care Excellence, 2019).
Chris Hunter added: ‘People with a learning disability have an increased risk of developing unrecognised health conditions due to difficulties they may have in understanding and communicating changes in their health needs. Regular medical review better identifies emerging health issues, opportunities to plan, advise or treat earlier and reduces the risk of unplanned hospital admissions.’
How can general practices improve uptake for people with learning disabilities?
Increasing uptake of annual health checks in this patient group is important for reducing health inequalities. Lisa Harrington said: ‘GPs could improve the uptake of annual health checks for people with a learning disability by making sure accessible information and reasonable adjustments are made and using their links with learning disability health and social services.’
Becky Hankin added: ‘The key to improving annual health checks and delivering high quality health checks for people with learning disabilities is maintaining positive working relationships between the learning disability health teams, learning disability social services teams and GP teams. People with learning disabilities need to be supported to understand the benefits of annual health checks and supported to achieve goals identified in their health action plan.’
It is important to ensure people with learning disabilities have been identified and added to the practices learning disability register.
Chris Hunter explained: ‘GPs can identify those eligible to have a health check and promote uptake with positive messages and education. They can make sure information is available in an accessible way, such as Easy Read and invite adults with learning disabilities along for their annual health checks. A detailed holistic assessment presents the best opportunities to learn a person's needs and consider advice that addresses these, an assessment does not always identify lots of issues. Health checks promote positive associations, not just relationships, with health services.’
The Kent Community Health NHS Foundation Trust is looking at how it can further help GPs, primary care networks and clinical commissioning groups, to encourage a higher percentage of patients to have their annual health check.