GP Practices and People with Learning Disabilities

1. GP Practices and People with Learning Disabilities Jackie Williamson and Sally Henderson Learning Disability Health Facilitators Nottingham CityCare Partnership

2. Aims and Objectives: • To provide an understanding of what learning disability . • To start to look at identifying the health needs of people with a learning disability. • To begin to show how practices are able to offer support to people with a learning disability. • To promote the use of appropriate and easily understandable communication.

3. LearningDisability Learning disability is the term preferred by health organisations to describe: A significantly reduced ability to understand new or complex information or learn new skills (impaired intelligence) along with; A reduced ability to cope independently (social function) and; which started before adulthood, with a lasting effect on development. (Valuing People 2001)

4. Degrees of Learning Disability. Mild IQ - range 50-69 (89% of people with a learning disability). Moderate IQ 35-49 (6% of the learning disability population) Severe IQ 20-34 (3.5% of all individuals with a learning disability) Profound IQ less than 20 (1.5% of all individuals with a learning disability.)

5. What is NOT a Learning Disability. Problems with reading, writing or numeracy only. Emotional difficulties. Conditions like Attention Deficit Hyperactivity disorder (ADHD) Asperger's syndrome and some individuals with Autism. However you can have a learning difficulty as well as a learning disability.

6. Causes of Learning Disability Prenatal – chromosome, genetics, toxins. Perinatal – Birth complications, infections. Post natal- infections or trauma. A learning disability will have started before adulthood. After adult hood people may have brain damage resulting in significant impairment of both intelligence and social functioning, but they are not considered to have a learning disability, often referred to as having an acquired brain injury.

7. Prevalence of Learning Disability National prevalence estimated at 2-3%. Approximately 210,000 people with a severe or profound learning disability, of which: Mild to moderate 25 per 1,000 population (1.2million) Approximately 86,000 People across the East Midlands.

8. Barriers to services Communication Unaware of what’s available Physical access Difficulties in reading & understanding Fear of health professionals Lack of time Difficulties in having to wait Physical environment Poor information from carers Additional needs/ mental capacity

9. Good Communication Guide Keep your head up and look at the person Speak clearly and use simple language Take time Use visual clues to support understanding

10. Give information in small chunks and short sentences Accept and know about peoples communication Do not ask too many questions Check out understanding

11. Annual Health Check • Provides an opportunity to check and review health action file and plans • Offer health advice and health promotion • Promotes good relationships and can help desensitise any fears • Health checks make sure that health needs are identified and met • Allows reviews of current health needs and medication

12. Content of health check Range of physical health checks- blood pressure monitoring, height and weight (BMI), ear examination, urinalysis, foot examination and a general heath assessment including: Medication Eating and drinking. MobilityMental health ExerciseBehaviour Optician Dentist Skin Screening participation Hearing / Audiology

13. Fungal nail infections, Ear wax, Hernias, Obesity, High blood pressure, High cholesterol, Diabetes, Breast cancer Incontinence, Constipation, Bone fractures, Heart conditions, Dysphagia, Need for optician appointments. Need for dental care. Health checks have found…..

14. Diagnostic overshadowing This means when a person's presenting symptoms are put down to their learning disability, rather than seeking another, potentially treatable cause. For example, when a person presents with a new behaviour or existing ones escalate, you should consider: Physical problems - pain or discomfort, e.g. from ear infection, toothache, constipation, reflux oesophagitis, deterioration in vision or hearing. Psychiatric cause - depression, anxiety, psychosis, dementia. Social cause - change in carers, bereavement, abuse

15. Things that could make it easier Use Health Action Plans Consider a double appointment Involve the patient and carers in discussions about care Moving the person from a busy environment if possible can decrease anxiety and confusion levels. It is possible that the person may present with challenging behaviours. Be aware of the person’s environment and what could be contributing to the behaviour. Use the Learning Disability Health Facilitation Team for support

16. Further Support • Learning Disability Awareness Training • DES Training • Easier Read Information • Short term support for individuals with a Learning Disability • Support for practices to identify people with a learning disability • Support for practices with health needs of people with learning disability.

17. Thank you for listening

18. Further information Signposts for Success (DH 1998) Once a Day (DH 1999) Facing the Facts (DH 1999) Valuing People (DH2001) Treat me right – Mencap (2004) Equal treatment : Closing the Gap (2006) Our Health, Our Care, Our Say (DH 2006) Death by Indifference – Mencap (2007) Good Practice in Learning Disability Nursing (DH 2007) Valuing people now (2008) Healthcare for all (2008) Equal Access (DH 2009) Six lives: the provision of public services to people with learning disabilities (2009)

19. Learning Disability Health Facilitation Team Jackie Williamson jacqueline.williamson@nottinghamcitycare.nhs.uk Sally Henderson sally.henderson@nottinghamcitycare.nhs.uk Tel: 0115 8834859