Guidance on LD Annual health check delivery for DES payment
Last week’s Learning Disabilities Mortality Review (LeDeR) Annual Report shows that, thanks in large part to general practice, great progress is being made to ensure that people aged 14 and over on the learning disability register receive an annual health check with 74% of checks undertaken. As a result of your efforts during a very challenging year, we are on track to meet the ambitions of the Long Term Plan of 75% by 2023/24.
Thank you for continuing to complete all parts of the health check – including the face-to-face physical review – over the year to improve patient outcomes. To qualify for payment under the DES the health check does not need to be in a single consultation. Input from patients, family and carers into the choice of conducting the health check face to face or conducting some elements remotely should be sought. Reasonable adjustments can be offered to support patient and carer needs. This short film can support primary care teams to consider a simple range of reasonable adjustments that may be helpful in making consultations more acceptable and accessible for people with a learning disability and autistic people.
In the following link you’ll find the LeDeR Stakeholder briefing for information which describes some of the work being undertaken across the country by the NHS to reduce health inequalities and premature mortality amongst people with a learning disability.
Learning Disability Annual Health Checks – achievement of national standard
We are pleased to announce that provisional data for end of March 2021 shows we have exceeded the year end target of over 67% of people with LD receiving their annual health check.
Thank you and well done to all staff involved with prioritising this work and ensuring this high risk group received their health check and achieved this national standard, especially as the Covid pandemic has highlighted inequalities in healthcare outcomes, so it is timely that we have significantly improved the delivery of this programme. A considerable amount of checks have been completed in Quarter 4 to make up for those not undertaken earlier in the year due to the pandemic. We will continue to work with practices who didn’t meet the standard to ensure plans are in place to complete health checks during 21/22 to provide an equitable service across our population.
NHS England have emphasised that AHCs for people with LD remains a priority, in order to reduce the risk of increased unnecessary deaths in people with a learning disability. A number of studies and extensive research has concluded that people with learning disabilities (LD) have poorer physical and mental health than other people and die at a significantly younger age. The greatest difference between people with learning disabilities and the general population was in relation to medical causes of death which are treatable with access to timely and effective healthcare. A third of deaths of people with learning disabilities were from treatable medical causes, compared to 8% in the general population – a four-fold difference. This is not inevitable. These are health inequalities that can, to a significant extent, be avoided. One approach of proven value is annual health checks to identify developing health problems early, to check that people are getting the right healthcare, current treatments are appropriate and working and to familiarise people with learning disabilities with their GP and the surgery, establishing trust so they are better able to use them when the need arises.
Thanks again for your continued hard work. Practice level data will be shared directly with practices shortly.
| CCG Area | Sum of LD Health Checks (aged >14yrs) | Sum of LD Register aged 14+ eligible for AHC | % LD AHC completed on eligible cohort (14+) |
|---|---|---|---|
| Cannock Chase | 627 | 770 | 81.4% |
| East Staffs | 483 | 728 | 66.3% |
| North Staffs | 816 | 976 | 83.6% |
| SES & SP | 673 | 920 | 73.2% |
| Stafford & Surrounds | 390 | 470 | 83.0% |
| Stoke-on-Trent | 1460 | 1777 | 82.2% |
| Grand Total | 4449 | 5641 | 78.9% |
Continued focus on vaccinating the at-risk groups
Please also continue to encourage those from at risk groups, those with long term conditions and those on (or in contact with someone who is on) the learning disability register to come forward to take-up their offer of a vaccine, as we are continuing to see lower uptake among these groups.
We have also uploaded a number of learning disability register assets below for you to share across your social media channels, websites and with your local contacts and communities where appropriate.
Other resources that may be of use include:
Learning Disability AHCs
Please remember to use the correct national template in your system library called “National template for LD annual health check – template runner” and ensure that the final box is ticked. This box must be ticked in order for the health check to be treated as completed. This is often the reason for data anomalies and practices thinking they have completed AHCs but the numbers are not reflected in the CCG report. You may want to check that this box has been ticked to ensure all your completed AHCs are being reported.
See example attached and advice from NHSE around allowing more flexibility with a personalised approach for delivery of AHCs due to the impact of the pandemic.
Updated version of easy read vaccination invitation letter for people with a learning disability
The easy read vaccination invitation letter for people with a learning disability has been updated and the new version should now be used when calling these patients for a vaccination appointment. The previous version should be deleted, and your teams advised of this change. The letter has been updated to allow the opportunity, should individuals and their families wish, to attend mass vaccination sites and pharmacies by contacting the National Booking Service via 119. Appropriate system arrangements are now set-in place to facilitate these arrangements.
Please also continue to use the accessible resources produced in collaboration with people with lived experience to support clinicians and non-clinicians in communicating with people with a learning disability and their family carers. These include a Covid-19 Vaccine film, Public Health England’s easy read Covid vaccination leaflet, ‘What to expect after the vaccine’ leaflet and adult consent form and additional training materials for COVID 19 vaccinators and volunteers which provide top tips on communicating with people with a learning disability and autistic people and reasonable adjustments that should be considered.
LD Annual Health Checks
NHS England have emphasised that AHCs for people with LD is a priority throughout the covid pandemic. “In order to reduce the risk of increased unnecessary deaths in people with a learning disability during the coronavirus outbreak it is essential that annual health checks continue to be carried out.”
A support pack is attached for GP Practices re-starting Annual Health Checks, other resources are also available on the Covid Response Website.
The practice level data will be shared separately with practices and we would appreciate your support to ensure that people with LD are receiving their annual health checks.
LD Heathcheck questionnaire
The LD health check pre-questionnaire has been developed locally by the Community LD nurse specialists to provide information to support the AHC.
We hope you find this a useful resource
LD healthcheck questionnaire V.2
Learning Disability Annual Health Checks – Advice and Support Pathway to Completing AHCs
Please can we emphasise the importance of completing Annual Health checks for people with learning disability and to request that you really prioritise this from now until 31st March 2021.
A number of studies and extensive research has concluded that people with learning disabilities (LD) have poorer physical and mental health than other people and die at a significantly younger age. The greatest difference between people with learning disabilities and the general population was in relation to medical causes of death which are treatable with access to timely and effective healthcare. A third of deaths of people with learning disabilities were from treatable medical causes, compared to 8% in the general population – a four-fold difference. This is not inevitable. These are health inequalities that can, to a significant extent, be avoided. One approach of proven value is annual health checks to identify developing health problems early, to check that people are getting the right healthcare, current treatments are appropriate and working and to familiarise people with learning disabilities with their GP and the surgery, establishing trust so they are better able to use them when the need arises.
GPs and practice nurses have the much needed generalist skills to help people with LD get timely access to increasing complex health systems. Please find attached the excel spreadsheet identifying performance against each practice code against the target of 67%.
Priority for NHS
NHS England have emphasised that AHCs for people with LD is a priority throughout the covid pandemic. “In order to reduce the risk of increased unnecessary deaths in people with a learning disability during the coronavirus outbreak it is essential that annual health checks continue to be carried out.”
NHSEI have produced a support pack ‘Midlands Region Support Pack for GP Practices Re-starting Annual Learning Disability Health Checks’ which can be found at Appendix 1.
Payment for Annual Health Checks
Important – Virtual or Remote Annual Health Checks
Healthcare Professionals should discuss with the patient (if considered to have mental capacity), their carer or their advocate the most suitable and safe way to conduct a health check. Where this can be delivered safely on a face to face basis this should continue. Where this care cannot be delivered safely face to face or where the patient has other medical conditions which require them to shield or socially isolate the review could be conducted remotely, with as much of the physical review completed as is practicable in these circumstances. Practices should use their clinical judgement and knowledge of the patient, together with the advice of family or other carers, in determining whether they would be able to participate in a remote review. Reasonable adjustments should be made to accommodate the needs of patients and carers as well as considering the capacity and capability of the GP practice whilst working in different ways. Where practices can demonstrate that they are taking an individual approach to health check delivery and are completing as much of the prescribed elements as practicable then they will be eligible for payment under the DES during 2020/21.
Annual Health checks for people with LD are part of three funding streams.
Therefore, payment is available for AHCs completed up to 31st March under the DES, and these payments will still be paid where checks are initialised online and for partially completed AHCs where face to face checks are not possible. The spreadsheet identifies payments already achieved and payments that could be paid for further checks carried out up to the 67% target.
An example of best practice can be found at Appendix.2.
In addition, there is an excellent toolkit to support Annual Health checks for people with learning disabilities. You can access by clicking this link: https://www.rcgp.org.uk/clinical-and-research/resources/toolkits/health-check-toolkit.aspx
Should you have any queries or difficulties then please do not hesitate to contact the following people:
Dr Waheed Abbasi: Waheed.Abbasi@NorthStaffsCCG.nhs.uk
Dr Murray Campbell: murray.campbell@nhs.net
Equally, if you feel that your patient may require some community support then please feel free to contact the below emails/ phone numbers:
North Staffordshire Combined Healthcare Trust:
Midlands Partnership Foundation Trust:
Children and Young People’s Learning Disabilities:
Adult Learning Disabilities:
The Health Facilitation Teams from MPFT and NSCHT have produced a pathway for completion of Annual Health Checks, these can be found at Appendix 2 and Appendix 3 respectively.
You can contact the Health Facilitation Leads as below:
NSCHT: The named lead for your practice can be found in Appendix 5
MPFT:
CCG Primary Care lead:
Reasonable adjustments to support LD Annual Health Checks.
This resource has been developed with our clinical leads and community LD nurse specialists to support when making arrangements for an Annual Health check.
The clinician should consider if any reasonable adjustments are required in order to have a successful appointment.
The document provides some examples of Reasonable Adjustments that can be made for people with Learning Disabilities, an accessible summary and communication jargon buster. Reasonable Adjustments
This will be available on the COVID Response website together with other useful resources recently shared with practices.
Primary Care COVID-19 Response Model 
