Learning disability - Annual Health Checks. Dr Jenni Lawrence.

Key documents 2019. LD mentioned on 13 pages. Practices are likely to have a key role in helping ensure high and timely uptake of screening and case finding opportunities within their neighbourhoods.

Key themes from LTP for LD Priority area for care quality and outcomes improvement Key area for inclusion in personal health budgets Reduce smoking rates Tackle inequality in health – lead happier, healthier, longer lives Focus on reducing premature mortality Reduce inpatient care for the more complex Improve numbers being trained in LD nursing Get more people with LD into employment Designated key worker for children with LD

Lead happier, healthier, longer lives Increase Annual Health Check uptake to 75% Engage in STOMP programme Engage with LeDeR programme

42% premature deaths in people with LD thought to be preventable. CIPOLD 13 years for men and 20 years for females. ( ave 16 years) 2013. and LeDeR 23 years men, 29 years women 10% cancer, 31% resp, 16% CVD.

Associated health problems of people with LD (2 Associated health problems of people with LD (2.5x as many co-morbidities as other patients) Psychiatric and behavioural problems more common Anxiety and depression 5X Schizophrenia 3X 30% epilepsy 30% visual problems 30% hearing problems Vulnerable to abuse by carers and others Many Down’s pts develop dementia in middle age c30% Down’s patients become hypothyroid

Annual Health Check. L.E.S with payment attached. Yearly review at GP surgery for those with LD Offered to all over the age of 14. To pick up illness early and to help people stay healthy. Gain consent during this visit to share information with other health care professionals including the screening services. Opportunity to give information to people.

Proportion of practices doing at least one annual health check has gone up form 73.6% in 2014 to 93.3% in 2017. More people are annual health checks from 20.1% of those eligible on the LD registers in 2014 to 45.4% in 2017. More people are getting a Health Action Plan - 14.3% in 2014 vs 38.7% in 2017 And percentage of HAP not recorded gone down from 85% to 55.6%. This is based on the most recent data although due to be updated any day now.

Where are we now? AHC fallen to 40.2%. 9/11 CCG in our cluster But the best in our cluster is still only at 50%. 167/207 Completeness of our register we are 65/207. England average 48.9%.

So…. How do we get to 75%?! Invite – Formal invite vs Opportunistic Who does your AHCs? Which template do you use – Bespoke vs National template What reasonable adjustments have you made? What is your rate of AHCS?

National template.

Examples of reasonable adjustments –make sure their diagnosis is coded as a significant active problem on the records –make sure their carers are on the carers register if appropriate –highlight any reasonable adjustments that are needed to allow the patients or their carers to access services - see the section below –make sure these adjustments are clearly “flagged” on the records –if someone is registering at the practice and they are anxious about visits, arrange some time to visit when no interventions are needed –encourage them to use a patient passport and take it to appointments in case they see a member of staff who does not know them –if they do not understand something – encourage them to say so –if you refer them to hospital or to another secondary service for tests or treatment, write on the referral letter the reasonable adjustments they will need

•be prepared to make early/late appointments or longer appointments •provide somewhere quiet to wait •allow them to see the same clinician if at all possible (recognising that in an emergency this may not be possible) •nominate a key named contact person who will navigate the system, this may be a receptionist, administrator or nurse or GP •provide alternative ways of booking appointments, such as on-line, that do not involve the telephone •explain at the beginning of the consultation what will happen and how long it should take •recap and write down the key points at the end of the consultation for them to take away •provide accessible information in a format they understand about how and when appointments are available and how to get prescriptions or access services like cancer-screening tests.

Self Assessment Tools. 1.How well is the GP practice doing at performing the AHC? 2.How well are we doing at identifying patients with learning disabilities? 3.How well are we doing at arranging for people to attend for a health check? 4.How well are we doing at putting reasonable adjustments in place to maximise the effectiveness of AHCs? 5.How well are we doing at arranging for and supporting the uptake of follow-up actions? 6.How well are we doing at improving our practices? https://www.ndti.org.uk/resources/useful-tools/quality-checking-health-checks-for-people-with-learning-disabilities

http://www.rcgp.org.uk/clinical-and-research/toolkits/health-check-toolkit

http://www.scarboroughryedaleccg.nhs.uk/rss2/Learning-Disability

Learning disability and Cancer screening.

Bowel screening Bowel screening using a faecal occult blood test is offered every two years for men and women aged 60-75 years. A bowel scope screening programme is in the process of being rolled out to all 55 year olds in England 0-62.5% (61.8%)

Breast screening. Breast screening is offered once every three years to women aged 50-70 years old. The programme is in the process of being extended as a trial to invite women aged 47-73. 0-66%. (74.8%)

Cervical screening. Cervical screening is offered once every three years to women aged 25-49 years and once every five years to women aged 50-64 years. Rates variable from 0-100% across the practices. ( in gen pop 77.4%)

Scarborough screening rates 2016 – 2017 We have made no difference.   % Screening in LD population – SRCCG 2016 2017 % Screening in General population 2016/2017 Cervical 32% 28% 72.1% Breast 45% 35% 73%  Bowel 36% 40% 62.7% Room for improvement. Data gathered 2016.

Barriers? Health care professionals Person with LD Carers Physical environment Systems

What did people say? Easy Read leaflets are really helpful. It was uncomfortable and I did not understand. What did people say? Don’t be afraid to talk about it. Easy Read leaflets are really helpful. Why it is important? Awareness of worrying symptoms and signs. Train (someone) to talk things through first. What the outcome of being screened might be? Make sure physically accessible. What happens during screening? Comments from the Health task force group. Understanding whose responsibility it is. Be clear that people understand.

Reasonable adjustments Flagging to screening services. Easy read invites and information. Longer appointments. Pre-visits to surgery/ mammography. Desensitization with LD team. Support of Acute Liaison for breast screening and bowel scoping.

https://www. diabetes. org https://www.diabetes.org.uk/Professionals/Resources/shared-practice/for-people-with-learning-disability