Quality statement 2: Annual health check
Annual health checks in people with a learning disability are likely to lead to identification and management of underlying physical health problems at an early stage. Unrecognised physical illness in people with a learning disability may lead to pain and discomfort, which, in turn, may be an important factor in triggering and maintaining behaviour that challenges. Therefore, early identification of physical health problems in people with a learning disability may reduce behaviour that challenges, leading to a reduction in costs associated with assessing and managing such behaviour.
Evidence of local arrangements to ensure that people with a learning disability have an annual health check from their GP.
Data source: Local data collection.
Proportion of people with a learning disability who have an annual health check from their GP.
Numerator – the number in the denominator who had an annual health check from their GP in the past 12 months.
Denominator – the number of people with a learning disability in contact with a GP service.
Data source: Local data collection.
Service providers (primary care providers) ensure that people with a learning disability have an annual health check from their GP.
Healthcare professionals (GPs) carry out an annual health check for people with a learning disability.
Commissioners (clinical commissioning groups and NHS England) ensure that they commission services in which GPs provide an annual health check for people with a learning disability.
People with a learning disability have a thorough health check from their GP every year. This should include checking their physical health and any medicines they are taking. The checks should help to plan the person's healthcare over the next year and make sure that any physical health problems are treated.
Challenging behaviour and learning disabilities (2015) NICE guideline NG11, recommendation 1.2.1
Learning disabilities and behaviour that challenges: service design and delivery (2018) NICE guideline NG93, recommendation 1.2.23
An NHS initiative for adults and young people aged 14 and over with a learning disability to provide additional health support and help to identify health conditions that could otherwise go undetected.
The enhanced scheme for providing annual health checks for GPs specifies details of the checks required, including that they should be undertaken by an appropriately trained provider and based on a protocol that as a minimum covers:
A review of any known or emerging behaviour that challenges and how it may be linked to any physical health problems.
A collaborative review of physical and mental health with referral through the usual practice routes if health problems are identified. This includes conditions such as epilepsy and dysphagia.
A specific syndrome check.
A check on the accuracy of prescribed medications.
A review of whether vaccinations and immunisations are up to date, for instance seasonal influenza, pneumonia or hepatitis B.
A review of coordination arrangements with secondary care.
A review of transition arrangements if appropriate.
A discussion of likely reasonable adjustments should secondary care be needed.
A review of communication needs, including how the person might communicate pain or distress.
A review of family carer needs.
Offering support to the person to manage their own health and make decisions about their health and healthcare, including through providing information in a format they can understand and any support they need to communicate.
[NICE's guideline on care and support of people growing older with learning disabilities, terms used in this guideline, NICE's guideline on challenging behaviour and learning disabilities, recommendation 1.2.1, NHS England's Learning Disability Annual Health Check electronic clinical template and Public Health England's People with learning disabilities: health checks audit tool]
Behaviour of such an intensity, frequency or duration as to threaten the quality of life and/or physical safety of the person, or others around them. It also includes behaviour that is likely to severely limit, or result in the person being denied, access to and use of ordinary community facilities.
[Adapted from NICE's guideline on learning disabilities and behaviour that challenges: service design and delivery, terms used in this guideline]
The communication needs of people with a learning disability, particularly the needs of people who are unable to communicate through speech, should be taken into account in a health assessment. Practitioners may need to provide support for those who have limited speech and for those who have difficulty with English.