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Learning Disabilities

This is what our GP trainees need to achieve during their time at your department. We've classified them under the six main compentency domains for general practice..

1. PRIMARY CARE MANAGEMENT

By the end of their GP Training Programme, the GP Registrar will be able to demonstrate:

• An awareness that a significant minority of any practice population will include patients who have mild learning disabilities, who may need no particular special services, but who may have reading writing and comprehension difficulties
• An awareness that there will be a few with special needs accessing services with moderate, severe and profound learning disabilities who need to be identified, monitored and reviewed appropriately
• An awareness of likely associated conditions; and the knowledge of where to obtain specialist help and advice

The knowledge base

Symptoms
• withdrawal, challenging behaviour, tearfulness, agitation, weight loss

Common and/or important conditions
• Epilepsy - increased incidence and complexity with severity of learning disability
• Sensory impairments - hearing and vision, earwax
• Psychiatric problems – emotional and behavioural disorders, sexual and physical abuse, schizophrenia, bipolar affective disorder, Alzheimer's disease in Down's syndrome
• Obesity - predisposes to other health problems, stigma
• GI - Swallowing problems, reflux oesophagitis, helicobacter pylorii, constipation, gastric carcinoma
• Respiratory problems - chest infections, aspiration pneumonia
• Cerebral palsy - especially with severe learning disability
• Orthopaedic problems - joint contractures, osteoporosis
• Dermatological problems

Emergency care
• In urgent life-threatening cases, treatment needs to proceed without consent in the best interests of person with limited capacity

Treatment
• Hurdles in the delivery of treatment due to difficulties reading instructions and treatment labels
• The risks of ‘over the counter’ prescriptions in some patients with a degree of independence, who may not fully understand how to take treatments or what the treatment is for
• Implementation depends on carers, the additional difficulties with drug delivery in inspected residential care homes
• hard to identify side-effects

Resources
• Specialist learning disability teams and non medical agencies

Prevention
 Health reviews proposed for people with learning disabilities

2. PERSON CENTRED CARE

By the end of their GP Training Programme, the GP Registrar will be able to demonstrate:
• An awareness of the particular importance of a person centred approach when consulting, often with communications involving carers
• A respect for the patient’s autonomy, which may be limited, and an awareness of how communicating via carers may skew the doctor patient relationship
• An awareness of residential situations, and attendance at day centres
• the ability to optimise communication through the use of consulting skills and communication aids
• An understanding of the importance of continuity of care in this group
• An awareness of the issues of Capacity and Consent and the mechanisms by which these can be determined

3. PROBLEM SOLVING SKILLS

The knowledge base

Symptoms
• withdrawal, challenging behaviour, tearfulness, agitation, weight loss

Emergency care
• In urgent life-threatening cases, treatment needs to proceed without consent in the best interests of person with limited capacity

Resources
• Specialist learning disability teams and non medical agencies

Prevention
 Health reviews proposed for people with learning disabilities

Specific problem-solving skills
By the end of their GP Training Programme, the GP Registrar will:
• Understand how psychiatric and physical illness may present atypically in patients with learning disabilities who have sensory, communication and cognitive difficulties
• Understand the need to use additional enquiry, appropriate tests and careful examination in patients unable to describe or verbalise symptoms.
• Be aware of the concept of diagnostic overshadowing (see appendix 1)

Moved from Psychomotor skills
By the end of their GP Training Programme, the GP Registrar will be able to perform a:
• Mental state assessment

4. COMPREHENSIVE APPROACH

By the end of their GP Training Programme, the GP Registrar will have:
• A working knowledge of associated medical problems in commonly encountered conditions which make up learning disabilities, including Down’s and Fragile X syndromes, Cerebral Palsy, and Autistic Spectrum disorder.
• An understanding of how health can be overlooked in PWLD and the remedial steps, such as health promotion, that can be taken

5. COMMUNITY ORIENTATION

By the end of their GP Training Programme, the GP Registrar will:
• Ensure that the health needs of patients with learning disabilities are met appropriately by primary care and community services
• Be aware of the roles of paid carers, , respite care opportunities, voluntary and statutory agencies, and an ability to work in partnership with them so there is cooperation without duplication.

6. HOLISTIC APPROACH

By the end of their GP Training Programme, the GP Registrar will have developed:
• A holistic approach to patients with learning disabilities, considering likely bio-psychosocial and cultural factors
• An understanding of the impact of learning difficulties on family dynamics and the implications for physical, psychological and social morbidity in the patient’s carers

All these 6 domains have a

7. Contextual Aspect

By the end of their GP Training Programme, the GP Registrar should:
• Be aware of the need to provide more time in the consultation in order to deal more effectively with people with learning disabilities.
• Understand the impact of the doctor’s working environment on the care provided to PWLD, e.g. the measures taken to compensate for sensory impairment

8. Attitudinal Aspect

By the end of their GP Training Programme, the GP Registrar should understand that:
• All citizens should have equal rights to health, and equitable access to health and health information according to their needs
• Integration is not simply a matter of health care professionals acquiring skills but rather of health care professionals showing commitment. Inclusion begins with commitment to the development of fully accessible services
• PWLD are more prone to the effects of prejudice and unfair discrimination and that doctor’s have a duty to recognise this within the self, other individuals and within systems and to take remedial action

9. Scientific Aspect

By the end of their GP Training Programme, the GP Registrar should be aware of:
• The scientific evidence regarding the health needs of people with learning disabilities (see Appendix 2)
• The evidence regarding the effectiveness of routine health interventions
• The importance of developing and maintaining continuing learning on physician-based issues that are barriers to healthcare including:
o a lack of specialist knowledge about health issues of people with intellectual disabilities
o a lack of awareness of appropriate specialist support services (behavioural support teams or psychiatric or neurological assessment) and their availability.