Introduction
This protocol sets out the practice’s approach to the creation of and the management of the learning disability register and the patients placed within it. The protocol is consistent with the QoF requirements of the Learning Disabilities DES.
Nature of Learning Disability
This definition comes from the DoH’s Valuing People document:
http://www.archive.official-documents.co.uk
Learning disability includes the presence of:
A significantly reduced ability to understand new or complex information, to learn new skills (impaired intelligence), with, a reduced ability to cope independently (impaired social functioning); which started before adulthood, with a lasting effect on development.
This definition encompasses people with a broad range of disabilities. The presence of a low intelligence quotient, for example an IQ below 70, is not, of itself, a sufficient reason for deciding whether an individual should be provided with additional health and social care support. An assessment of social functioning and communication skills should also be taken into account when determining need. Many people with learning disabilities also have physical and/or sensory impairments. The definition covers adults with autism who also have learning disabilities, but not those with a higher level autistic spectrum disorder who may be of average or even above average intelligence – such as some people with Asperger’s Syndrome.
‘ Learning disability ‘ does not include all those who have a ‘ learning difficulty ‘ which is more broadly defined in education legislation.
People with learning disabilities have the right to the same level of medical and nursing care as that provided to the general population. This care must be flexible and responsive and any diagnosis or treatment must take into account any specific needs generated by their learning disability. Evidence suggests that those with a learning disability have more health problems than the general population.
Research has demonstrated that people with learning disabilities have greater health needs than the general population, may have difficulty accessing primary care and have lower uptake rates of routine screening than the general population.
Individual ” learning styles “, ” learning differences “, ” academic problems ” and ” test difficulty / anxiety ” in and of themselves do not constitute a learning disability. It is important to rule out alternative explanations such as emotional, attention, or motivational problems that may be interfering with learning but do not constitute a learning disability.
DES Requirements
The directed enhanced service requires a register and an annual health check for all patients older than 18 years old, including those on the local authority register, using the agreed protocol of Cardiff Health Check.
To facilitate this service, a GP, practice nurse and administrative member of the practice staff attended a PCT organised training day around learning disabilities. This enabled the practice to provide an effective lead within the practice.
Health checks will include;
- Health promotion
- Chronic illness enquiry
- A physical examination
- Epilepsy
- Behaviour and mental health
- Specific syndrome check
- Medication check
- Any secondary care coordination check
- Review of any transition arrangements
Protocol
The clinical lead within the practice for this register is Dr M Barhey
- A person with a learning disability should be identified in order to ensure that advance planning is undertaken to address any specific needs and where necessary to modify investigations or treatment to meet those needs.
- Where it is known that a person has a learning disability this will be coded into the clinical system [918e].This will highlight to secretarial, clerical, nursing, medical and other professional staff that the person may require specific care or support.
The following points may indicate a learning disability:
- Learning disability can be mild, moderate or severe.
- Specific Syndrome e.g. Down’s, Fragile X, Angelman, Cri-Du-Chat, Prader-Willi, Edwards.
- It is useful to find out what sort of school the person attended.
- Problems with understanding
- Has a Community Learning Disability Nurse
- Has a Learning Disability Social Worker/Care Manager• Has been seen by Psychiatrist in Learning Disabilities,
- Former terminology – mental handicap, mental retardation, intellectual disability
- People usually have a learning disability from birth or sometimes from early childhood
- Lives in a residential or nursing home for people with learning disabilities
A learning disability is not:
- Dyslexia (learning difficulty in educational legislation)
- People who have a learning difficulty (educational term)
- Presence of physical disabilities only
- Stroke victims
- Presence of mental health problem only
- ADHD
- Cerebral palsy
Creation of a Register
Valuing People (DoH, 2001) estimates that on average there are about 8 people with severe and 50 with mild/moderate learning disabilities on a practice list of 2000, our practice has a list size of nearly 12,000 and therefore we would estimate that we should have recorded 48 people with severe and 300 with mild/moderate learning disabilities.
As an initial base, the register will be established of those clients currently known to the practice. The practice will use the following criteria to assess whether someone has a learning disability:
Patients with the following diagnosis will be considered as suitable for inclusion to the register;
- Asperger’s Syndrome
- Autism
- Downs Syndrome
- Educational difficulties
- Turners Syndrome
- Congenital abnormalities
Regular contact should be made with the following organisations in order for their special needs register to be cross checked;
- Community Learning disability team
- Local Social Services
- Social Education Centres
All members of staff and clinicians dealing with incoming post from allied agencies are asked to bring to the attention of Dr M Barhey any comments regarding learning disabilities and the conditions listed above. The diagnostician must have used direct language in the diagnosis of a learning disability; avoiding such terms as “appears”, “suggests” or “is indicative of” as these statements do not support a conclusive diagnosis. The evaluation must be performed by a professional diagnostician (i.e. licensed clinical psychologist, rehabilitation psychologist, learning disability diagnostician, etc.) trained in the assessment of learning disabilities.