Health Checks

Why might it be of interest?

All GPs have a learning disability register and any of our young people with a learning disability should be on this register.  It is worth checking as while most GP practices will identify eligible young people some will slip through the net.  GPs are encouraged to offer annual health checks to people with learning disabilities and these regular checks are a really good way for the GP, the young person and their carers to spot early signs of health needs and to keep an eye on health needs.

Remember that health care needs for our young people is not just about physical health – it includes mental and emotional health, reasonable adjustments, understanding capacity to make health decisions, how you can best support your young person.

Health checks – what are they?

Annual health check are needed because people with learning disabilities:

• may not be able to tell people how they are feeling
• may not understand what they are feeling
• It is a joint check of the person’s physical and mental health (we will say what the check should cover later)
• Everyone aged 14+ on the learning disability register is entitled to one
• In order to do health checks – GP practices sign up to something called an Enhanced Service
• They get paid £140 for each health check they do
• Most GPs now offer health checks

What is the LD register?

• The learning disability register is different to the GP register
• All GPs have a learning disability register
• You can ask to be on the learning disability register if you have a learning disability
• Primary Care Liaison nurses often help GPs with the register
• GPs should work to improve the register. There is guidance to help them do this
• Being on the register means you should be offered a health check

Why are health checks important?

They help balance health inequalities

• Our age, sex, education, work environment, living conditions, housing can all affect our health
• Some disabilities come with a higher risk of health conditions
  • For example, people with Down syndrome are more likely to have heart problems and thyroid problems than other people
• What we do matters – do we take exercise, do we smoke, what do we eat?
• Friends and community matter – people with LD may have fewer friends and community support
• Where we work and live matters – people with LD may not work, they may not be able to access green spaces, health services might be difficult to use (for example they don’t have transport)
• Where we live, what we do, who we know, how health we can be – these are all linked together
• Health checks are one way of addressing inequalities – a reasonable adjustment, if you like

Preparing for your health check

• Spend some time thinking about your health and wellbeing before you Annual Health Check
• One idea is to think about your body from head to toe
• Remember health is not just about physical things but emotional wellbeing as well
• Talk to someone you trust to help you make a list of any concerns if you have any
• Make an appointment at a time that you feel most relaxed
• Think about what else you need to make your appointment easier for you (reasonable adjustments)
• One reasonable adjustment might be to break the health check down into manageable chunks and attend more than one appointment
• Ask a trusted person to accompany you to your appointment if you need
• Don’t be afraid to ask questions and to ask the doctor or nurse to explain what they are doing and what they mean if they use jargon
• Make sure you can understand the written Health Action Plan and get help to follow it
• Make sure you attend your appointment, it is important to pick up any health concerns early so they can be sorted out!
• Your GP might send you a form to fill in about all aspects of your health before the appointment
• This means that you and your GP can focus more on areas of need at the appointment which might cut down the time it takes

Mental Capacity Act and Health Checks

• Capacity – where capacity to consent to a health check is in doubt, it should be assessed
• Reasonable adjustments will support the person to make the decision if they can
• Best interests – if the person lacks capacity:
  • A relative who does not have deputyship cannot agree on behalf of the person, but their views taken into account when making the decision
• Any treatment needed following the check should be assessed separately

Things a health check should cover

• Checking communication needs, including how the person may communicate pain or distress
• A check of physical and mental health, including:
  • Weight
  • Blood pressure
  • What the person eats
  • Whether they are happy or sad
• Medication
• A condition specific check if appropriate
• A check of whether vaccinations and immunisations are up to date – including flu vaccinations
• A review of transition arrangements where appropriate
• Support to manage the person’s own health – using information in a format they can understand

What happens after a health check?

• The GP will write the actions into a Health Action Plan on their system
• You should be given a printed copy – it may not be in easy read
• It should say who will do what. There may be:
  • Tests such as blood tests or eye tests
  • Other appointments like screening for cancer
  • Advice on staying well- think about how you support the person to put into practice
• Updating Care and Support Plans and communicating with others who support the person

Reasonable adjustments – some things that do and don’t help

Things that didn’t help:

• Not getting a letter
• Lack of support to go
• Bad time of day
• Receptionist did not understand me
• Had to repeat myself which made me feel very anxious
• No quiet space to wait
• Didn’t clearly explain what I needed to do
• Difficult to understand the doctor, especially the jargon
• “If they would take some time to explain things better, I would know what to do.”

Things that did help:

• There was Easy read information
• Doctor explained things in a way I could understand
• The nurse stayed with me for the examination
• All the staff communicated well and took the time to help me
• Knowing what reasonable adjustments I needed
• Having good support during the health check
• It may be possible to have an online check if attending the GP is not a possibility