Learning Disabilities Annual Health Checks
There is a national expectation that proactive annual health checks (AHCs) for people with a learning disability (LD) should be continuing.
The associated Direct Enhanced Service (DES) has not been suspended.
All people with a learning disability age 14+ are eligible for this annual health check.
Why are Annual Health Checks important?
Health inequality remains a concern for people with LD who on average die 15-20 years sooner than the general population and often experience poorer health.
The mean age of death of people with profound or multiple LD is 40 years old. Unfortunately, often this is not due to complex co-morbidities but due to preventable, treatable conditions.
The CIPOLD Inquiry (2013) cited that people with a learning disability are three times more likely to die of a cause that could have been avoided than the general population.
During the COVID-19 response there has been a significant increase in the number of individuals with a learning disability who have died in Coventry and Warwickshire – a rapid analysis of these deaths confirmed a 140% increase in the number of deaths amongst this vulnerable group during March – May 2020, when compared with the same time period last year.
These individuals had varying severity of LD and lived in a range of settings. This review further highlighted the highly vulnerable nature of this group.
Feedback from local care and support providers has also highlighted the significant impact that the pandemic and associated isolation, change to routines/usual support provision has had on many people with LD.
Delivering Annual Health Checks to people with LD
NHSE advise that where the check can be delivered safely on a face basis, this remains the preferable delivery model for AHCs. However, where this cannot happen, for example, if a patient has medical conditions that require them to shield or isolate then the review should be conducted remotely.
Practices are required to use their clinical judgement to determine the most appropriate method for delivery of the Annual Health Check, also considering whether the patient is likely to participate in a remote consultation and whether they have the resources to do so.
Guidance issued by NHSE Midlands on 19th June 2020 confirms that GP practices can continue to be reimbursed for the delivery of the checks (£140 per check, per year) as long as the requirements of the DES are met.
It is essential that any LD AHCs that are performed are in line with the minimum requirements of the DES to ensure a uniform approach and that CQRS claims will be valid.
The minimum criteria are as follows
- A review of physical and mental health including:
The provision of relevant health promotion advice
A chronic illness and system enquiry
A physical examination
A consideration of whether the patient suffers from epilepsy
A consideration of the patient’s behaviour and mental health
A specific syndrome check
- The production of a health action plan for all patients with a learning disability who are aged 14 years and over
- A check on the appropriateness of any prescribed medications
- A review of coordination arrangements with secondary care
- Where appropriate, a review of any transitional arrangement which took place on the patient attaining the age of 18.
NHSE communication states that “The critical factor is not the mode of delivery but whether the requirements of the DES directions are being met”.
It is requested that the reasoning for any decision to deliver a remote Annual Health Check is recorded on the patient’s record for quality assurance purposes and should there be any challenge in relation to CQRS claims. See process map:
Support and Resources
Historically, local uptake/delivery of AHCs has been poor and performance has been far from the national ambition of 75% delivery across the LD population.
The CCGs in Coventry and Warwickshire are committed to improving this position and have worked collaboratively with the Community Learning Disability Team (CLDT) within CWPT to develop and enhance the support and training offer available to primary care.
This support offer is still available.
You can contact the CLDT Team Manager for your local area on the number below with any general enquiries, bespoke training requests and support with reasonable adjustments for people with a learning disability.
- North Warwickshire 02476 315867
- Coventry/Rugby 02476 324380
- South Warwickshire 01926 317746
To make a referral for a specific patient, please contact the Central Booking Service:
Tel: 0300 200 0011
Local charity Grapevine have recently worked with some young people with LD to co-produce some materials to promote annual health checks and also to refresh the supporting documentation available to practices.
In light of the focus on LD Annual Health Checks I wondered if it would be possible to have a specific section of the page dedicated to Annual Health Check Resources to include the following:
The Coventry Community Learning Disability Health Facilitator is Kelly Woodhead firstname.lastname@example.org who can provide support and training
A series of virtual Annual Health Check training sessions will be offered by CWPT during 20/21.
A range of useful resources including a full GP resource pack, leaflet to send to patients, easy read pre-health check questionnaire and a health action plan template are available on the following webpage https://www.covwarkpt.nhs.uk/learning-disability-services or click on the links below:
Annual Health Check Invitation Letter Template: click on image
Annual Health Check Leaflet: click on image
Pre Annual Health Check Questionnaire: click on image
Health Action Plan Template: click on image