Learning Disabilities Identification Protocol
Introduction
This protocol sets out the practice’s approach to the creation and management of the learning disability register and the patients on it. The protocol is consistent with the requirements of the Learning Disabilities DES which was launched in 2008, and is continuing through to March 2019.
This ES has since been extended and allows practices to offer medicals to patients 14 years or older and requires practices to produce a health action plan. The guidance for the learning disabilities ES for 2018-2019 is included in the GMS contract 2018-2019 – guidance and audit requirements document, which will be published on the NHS Employers website.
Nature of Learning Disability
This definition comes from the DoH’s Valuing People Document
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, attentional, 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 > 14 years old, including those on the local authority register, using an agreed protocol such as the Cardiff Check.
Practices should approach their CCG to liaise with local authorities to produce a practice list from central records. These patients should then be assessed for possible inclusion on the register.
To facilitate this, it is a normal requirement for nominated staff to attend CCG training around learning disabilities, in order 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
Practice procedure will be subject to a year-end audit report.
Protocol
The clinical lead within the practice for this register is Dr Abubacker.
- 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 (NB this list is not exhaustive):
- 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
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.
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 to be invited to join the register:
- Asperger’s syndrome
- Autism
- Down’s syndrome
- Educational difficulties
- Turner 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 [Insert clinical Lead name] 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.
Information will be displayed in the waiting room.
Learning Disabilities Register: Patient Information – Contacts
Angelman
ASSERT is a United Kingdom based support group run by volunteers who have direct contact with people with Angelman Syndrome. The majority of the trustees are parents or relatives of children or adults with Angelman Syndrome.
Web: www.angelmanuk.org
Address: ASSERT
PO Box 4962
Nuneaton
CV11 9FD
Tel 0300 9990102
Email: assert@angelmanuk.org
Autism
The National Autistic Society exists to champion the rights and interests of all people with autism and to ensure that they and their families receive quality services appropriate to their needs. The website includes information about autism and Asperger syndrome, the NAS and its services and activities.
Tel: 020-7833-2299
Fax: 020-7833-9666
Helpline Tel 0808 8001050
Email: nas@nas.org.uk or supportercare@nas.org.uk
Web: www.nas.org.uk
Address: The National Autistic Society
393 City Road
London,
EC1V 1NG
Cri-Du-Chat
This support group:
Support and friendship for families and carers throughout Britain
- Raises awareness of Cri-Du-Chat Syndrome amongst the medical profession and the public.
- Raises funds to promote research through carefully selected projects.
- Gives information and advice to families and professionals.
- Publishes a newsletter with general items of interest for families and carers.
Email: office@criduchat.org.uk
Tel 0845 0942725
Cri du Chat Syndrome Support Group
POBOX 73631
London
SW14 9BS
Edwards
S.O.F.T UK provides support for families affected by Patau’s Syndrome (Trisomy 13), Edward’s Syndrome (Trisomy 18), partial Trisomy, mosaicism, rings, translocation, deletion, and related disorders.
Tel: 0330 088 1384
Email: enquiries@soft.org.uk
Web: www.soft.org.uk
Address: SOFT UK
48 Froggatts Ride
Walmley
Sutton Coldfield
B76 2TQ
Fragile X
This society aims to:
- Provide support and information for Fragile X families from those who share and understand their concerns and needs
- Educate, inform and advise the public and professional people about the prevalence and nature of Fragile X in order to raise awareness and understanding of the syndrome and improve the care of all people affected by Fragile X
- Encourage research into all aspects of the syndrome and publicise the results
Tel: 01371-875100
Email: info@fragilex.org.uk
Web: www.fragilex.org.uk
Address: The Fragile X Society
Rood End House
6 Stortford Road
Great Dunmow
Essex
CM6 1DA
Prader-Willi
A registered charity and the only organisation in the UK which is dedicated to supporting people with Prader-Willi syndrome (PWS), their families, carers, and the professionals who work with them.
Tel: 01332 365676
Fax: 01332 360401
Email: admin@pwsa.co.uk
Web: www.pwsa.co.uk
Address: PWSA UK,
Suite 4.4, Litchurch Plaza,
Litchurch Lane,
Derby
DE24 8AA
Turner Syndrome
The Society provides accurate and up to date information on Turner Syndrome and the many aspects of living with the condition on a daily basis.
Tel: 0141 952-8006 Helpline 0300 111 7520
Email: turner.syndrome@tss.org.uk
Web: www.tss.org.uk
Address: The Turners Syndrome Support Society (UK)
12 Simpson Court
11 South Ave
Clydebank Business Park
Clydebank
G81 2NR
Down’s Syndrome
“Helping people with Down’s syndrome to live full and rewarding lives. The only organisation in this country focusing solely on all aspects of living successfully with Down’s syndrome.” They provide information and support for people with Down’s syndrome, their families and carers, as well as being a resource for interested professionals.
England and Wales
Tel: 0333 1212300
Web: www.downs-syndrome.org.uk/
Email: info@downs-syndrome.org.uk
Address: Langdon Down Centre
2a Langdon Park
Teddington
Northern Ireland
Unit 2 Marlborough House
348, Lisburn Road
Belfast
BT9 6GH
Tel: 02980 665 260
