The evidence has demonstrated that people with learning disabilities have difficulties accessing primary health care services: there are many reasons for this. GPs and other primary care staff receive little or no training in working with people with learning disabilities during undergraduate training and postgraduate vocational training, and the small number of persons with learning disabilities on their lists at any one time means it is difficult for them to gain experience once in practice. The average GP will be unaware of the different pattern of health needs experienced by people with learning disabilities, compared with the general population (and most work on the incorrect assumption that “common things are commonest”). Problems are compounded by the complexity of health need, communication difficulties, the tight appointment systems and reactive rather than proactive care necessary in busy practices.
The new GP contract, the implementation of which is currently being negotiated across the four U.K. countries, presents an opportunity to change this disadvantage experienced by people with learning disabilities. It is important that within these contractual arrangements, the needs of people with learning disabilities are clearly addressed. Provision of service for people with learning disabilities is listed as a possible group in the new contract for a local “enhanced service”. Given the current extreme disparity in health indicators, and the need for a more equitable service, it is recommended that for people with learning disabilities, “local” refers to Scotland-wide, with a Scottish service specification for an enhanced service and funding made available for local implementation across Scotland (rather than at the discretion of each locality). The enhanced service specification should include the requirement for completing education on health needs of people with learning disabilities, a flexible approach to appointments, working with carers and other professionals, and implementation of Part V of the Adults With Incapacity (Scotland) Act, 200047. The provision of
the enhanced service might be by all practices in the Community Health Partnership, or by selected practices, depending which model is best fitted to local needs.
In addition to the work with people with learning disabilities undertaken by all or most GP practices, the creation of Community Health Partnerships provides a locality structure for the development of one-stop health clinics for people with learning disabilities. These could provide on one site a group of primary care professionals with a particular interest in developing expertise in working with people with learning disabilities. This might include doctors, nurse practitioners, audiologists, opticians and therapists who could provide additional assessment, investigation, treatment and monitoring for physical health needs at a level beyond that appropriately managed within the enhanced GP service provided by all or most practices. Bringing together a number of professionals from cognate disciplines, interested in developing their learning disabilities expertise, will have the added value of team working and opportunities for professionals to learn from each others’ work. The one-stop health model would not be a replacement for existing GP and primary care services, it would be additional and complementary to them, bringing a greater level of expertise than that that can ever be available in ordinary primary care services. It also could develop as a training resource for GPs and primary health care professionals not employed to work in the one-stop health clinic, but working in practices providing an enhanced service for people with learning disabilities. It is important that the specialist learning disabilities service works in partnership with primary care services to support the needs of persons with learning disabilities and their carers. There is a role for learning disabilities health professionals in facilitating primary care, through a range of approaches. These include offering education and training, promoting awareness of the needs of people with learning disabilities, and facilitating primary care to improve access for people with learning disabilities. It is likely that community learning disabilities nurses, together with other learning disabilities health professionals, have the required skills to develop and provide this role. This could be provided through the establishment of a dedicated team of learning disabilities professionals to support primary care, or through locating learning disabilities professionals within Community Health Partnerships / primary care services. In the latter case, arrangements for peer support, audit and continuing professional development would need to be explicit with clear arrangements to reduce the effects of service fragmentation. This partnership between learning disabilities health professionals and primary care also provides one of several possible models through which the health screening programme for people with learning disabilities could be delivered locally. It is recommended that these partnership arrangements are developed in addition to the enhanced GP service and one-stop health clinics.
The Centre for Change and Innovation (CCI) was established in November 2002 within the Scottish Executive to provide NHS staff with practical support and expertise to improve care. The CCI supports the development of solutions to problems and supports national initiatives and priorities. One of their project areas, The National Primary Care Collaboration, aims to improve the experience and outcomes of every person by identifying and removing the barriers that cause delay and restrict access to services in primary care. This collaboration should be charged to consider specifically the needs of people with learning disabilities within its work. The CCI should develop its work programme to include support for the development of integrated health and social care services for people with learning disabilities.