Improving Care
Section: Improving Care | LD Toolkit template | RCGP Learning
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Improving Care
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Creating learning disability friendly practices in primary care is a vital step toward addressing the health inequality gap faced by people with learning disabilities. Such practices are welcoming and inclusive for patients with learning disabilities and their families or carers, support early identification and diagnosis. They deliver personalised, high-quality care and annual health checks and consistently implement reasonable adjustments to reduce barriers to access.
Achieving this requires whole-team engagement from reception and appointment booking to clinical care. Practices strengthen their approach by appointing a learning disability champion, making effective use of care coordinators, building strong links with community learning disability teams, and participating in local learning disability-friendly practice schemes to embed sustainable, meaningful change. There are many such schemes across England which award a 'Learning Disability Friendly' badge to GP practices designed with input from experts by experience; links to some examples are given below but this is not an exhaustive list.
NHS Coventry and Warwickshire: learning disability friendly badge
Hampshire and Isle of Wight Healthcare NHS: learning disability friendly GP practice award
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The Mental Capacity Act (MCA) 2005 is a legal framework used in England and Wales. It five core principles and uses a two-stage test that is decision-specific and time-specific. It helps protect and empower people aged 16 and over, who may not be able to make decisions for themselves. For people with a learning disability, it provides essential legislation to support decision making without discrimination and ensures a robust process is followed for those unable to make a decision. The links below will help you to make an assessment under the MCA and also give information about equivalent processes in Scotland and Northern Ireland. It is generally outside of the remit of a doctor to make an MCA assessment for a non-medical issue (such as making financial decisions or making a will) - we should use the MCA solely as it relates to medical conditions.
Adults with Incapacity Act - Scotland
Department of Health Northern Ireland: mental capacity act
BMA guidance: mental capacity in England and Wales
NHS England: mental capacity act
Bournemouth University: mental capacity toolkit
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To enable patients to access healthcare it is often necessary to make reasonable adjustments. This involves removing barriers which disadvantage disabled people in physical environments, processes and communication and is a legal requirement under the Equality Act (2010)
Reasonable adjustments may be general, such as disabled parking or accessible toilets, or tailored to an individual. Perhaps someone who becomes anxious in crowded rooms could be offered appointments at a quieter time. Do you have information regarding health interventions such as vaccinations or screening in a more accessible format?
NHS Digital: reasonable adjustment flag
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Effective communication and inclusivity of language is key to improving communication for professionals in health and care. People with a learning disability may need more time for understanding and discussions. You may need accessible resources such as pictures, easy read guides and videos to illustrate your discussions.
The Learning Disability Network: communication top tips for healthcare professionals
NHS Leeds Easy Read patient resources
NHS England: making information and the words we use accessible
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Diagnostic overshadowing describes a situation where the symptoms of physical ill health are mistakenly attributed to a mental health or behavioural problem. If a person with a learning disability communicates without words, the only way they might be able to tell you they are in pain or feel unwell is by banging their head or shouting out. So if someone with a learning disability is displaying 'challenging behaviour', think why might this behaviour be happening and what might someone be trying to tell you?
Royal College of Nursing (RCN): all you see isn't all there is - looking beyond learning disability
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Having a learning disability can leave a person vulnerable to exploitation and their carer becomes responsible for not only the activities of daily living such as good diet and washing, but also protecting their loved ones/clients from harm.
Children and adults with a learning disability are at significantly higher risk of all types of abuse and may not have a voice to raise concerns. Institutional abuse has also been reported several times. As GPs we may be aware of safeguarding concerns which have to be addressed.
RCGP: safeguarding standards for general practice
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LeDeR, 'learning from lives and deaths in learning disability and autism' reviews the deaths of people with a learning disability every year since 2017. The most recent report reviewed the deaths of over 3500 people who died in 2024. The median age of death was 63 and people with a learning disability were found to be dying about 20 years younger than the general population. People with severe and profound disability died even younger.
If a patient of yours dies you can report their death to LeDeR. Reporting a death is not mandatory but it enables a review of notes to improve the understanding of people’s health and to identify areas for improvement
NHS: report the death of someone with a learning disability or an autistic person
KLC: LeDeR report on constipation related deaths in 2021
KCL: Leder 2024 deaths due to pneumonia in people with a learning disability
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