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Clinical Knowledge

Learning & Intellectual Disability


According to Public Health England, about 2.5% of the population has a learning disability (LD). Yet most GP LD registers show only about 0.4% of their practice population. The ‘missing’ 2% might be people with a mild learning disability, or with other diagnoses which appear on the disease register but are not separately recorded. This includes, for example, people with Down’s Syndrome, autism or cerebral palsy that also have a learning disability.

Why is this area important?

Because people with a learning disability face many distinct health inequalities:

  • Significantly reduced life expectancy, 18 years lower for women and 14 years lower for men (NHS Digital 2017-18).
  • Poorer nutrition and increased likelihood to be either obese or underweight. They are less likely to have help for their obesity, including screening for thyroid disease and diabetes.
  • Very low attendance in the three national cancer screening programmes (breast, bowel and cervical).
  • Very low uptake of flu immunisation yet respiratory infection is one of the most frequent causes of preventable deaths.
  • The Confidential Inquiry into premature deaths of people with learning disabilities (CIPOLD) found, over a quarter of deaths could be prevented with better-quality healthcare. Recently, the learning disabilities mortality review (LeDeR) raised this figure to over a third.
  • Greater prevalence of epilepsy and severe mental health illnesses. Also, multimorbidity, complexity, polypharmacy and greater likelihood of adverse events from incompatible interventions (PHE 2017).

Important features in the history

  • If you would like to have a go at adding some “top tips” to this page for this specialty (and have your name displayed proudly with bradfordvts),  please email me –

Important features in the Examination

Red Flags

The main thing is to optimise psychotropic medication in line with STOMP and STAMP.

The other thing is to do an Annual Health Check – because these group of patients get missed – but then go on to develop morbidity and mortality from unrecognised disease.

How to improve care in Learning Disabilities

To focus on improving care of people with a LD to:

  1. Develop a system to identify people with LD
  2. Increase the uptake of annual health checks (AHC)
  3. Optimise psychotropic medication in line with STOMP
  4. Identify & record reasonable adjustments
  5. Help the patient engage with community resources via social prescribing to health & wellbeing
  6. Link up with other GPs.  Form a network peer review meetings

Full info: 

Anyone with LD > Age 14 should:

  1. Be offered a specific LD related Annual Health Check
  2. Have a health action plan to address health issues identified in the check. You could include the social prescribing contact in your practice to support people to be able to address these actions.

Practices must:

  • Maintain a ‘health check register’ of patients aged 14 & over with LD
  • Check the number on their LD register reflects the current prevalence (at least 0.5%). 
  • Nominated lead for LD who coordinates: staff training, delivering the ES and provides the AHCs
  • Have a MDT education session

Other Top Tips - practice tips.

THiNK LD campaign

How do I THiNK LD?

Use my mnemonic LEAF.   L is for Learning Disability.   E is for Equality.  A is for Access.  F is for Flexible.    So, in Learning Disabilities, think E, A, F. 

    Is there anything stopping people with learning disabilities using the service our surgery provide?
    Can our surgery offer any adjustments that could improve people’s experience?
    Will people with learning disabilities have the same outcomes as anyone else?


What could be a reasonable adjustment? 

  • Longer appointments? 
  • Quiet end of the day

 The Accessible Information Standard (AIS) 

The NHSE introduced the AIS to help clarify what is reasonable under the Equality Act 2006 to ensure people who have a disability, impairment or sensory loss receive information they can easily read or understand, and get support so they can communicate effectively with health and social care services. It covers patients, their parents and carers.   


Please leave a comment if you have a tip, spot an error, spot something missing or have a suggestion for a web resource. And of course, if you have developed a resource of your own, please email it to me to share with others.

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