Barnet Story

Learning disability Metrics 8.01, 8.02, 8.03, 8.04

Introducing a Joint Health Check Clinic at a General Practice led by practice nurse in partnership with a community learning disability nurse.

Why did we choose these Metrics?
Why did we decide to choose these metrics?
Improvements
Barriers that needed to be overcome
Key Messages

Why did we choose these Metrics?

There were a number of reasons why we chose these metrics to work on:

Evidence of unmet health need in primary care for this client group
Evidence from Wales and Birmingham that says regular health checks in primary care do improve health outcomes for this population.
An application for an enhanced payment system to carry out health checks had received a very positive response, but no financial support meant that this did not progress.
Thought that the project would give practices in primary care kudos, being involved in a DH funded project led by the Foundation.
The GP practice was enthusiastic – Lead GP who championed the needs of this population.

Why did we decide to choose these metrics?

We wanted to ensure that a person’s HAP was seen as a responsibility for Primary Care. The health check within the practice would ensure that the HAP was seen in Primary Care, and would enable the practice to input directly into the HAP.

Improvements

A few people accessing their GP for the first time
Longer time slots were allocated to ensure people did not feel rushed.
In conjunction with the IT dept established a template to carrying out health checks in GP practice
Information was provided in Primary Care setting in an accessible format.
Practice Nurse developed improved communication skills
Practice Nurse developed skills and confidence to talk about sensitive issues and understanding of informed consent.
People with Learning Disabilities felt valued having their own personal time to discuss their health
One family had a bad GP experience: this clinic enabled this to be ironed out and the family regained confidence in the practice.
Some people with learning disabilities who had been anxious to attend their GP practice, after the clinic felt confident to attend independently.
Discussions around cervical and breast screening with accessible information is likely to improve the take up of screening appointments.
The practice developed a system to provide people with 1: 1 support to access Choose and Book.
The practice started to understand the local Learning Disability Network and what help was available, and who they could refer on to, or sign post people to.
Community Learning Disability Nurse gained knowledge of general practice; being familiar with their systems enabled help to be geared to meet these needs.
The relationships between the practice and learning disability services vastly improved . Relationships had always been good with this practice, but running these clinics on a regular basis enabled both the practice and learning disabilities service to have a greater understanding of each other’s areas
Other practices beginning to contact the LD service wanting to commence a similar service.
This was a good opportunity to raise the issues for people on a micro and macro level and this project raised an awareness of the better metrics for learning disabilities and these were then adopted as part of the quality audit for the QOF (quality outcome framework) .

Barriers that needed to be overcome

Information and letters were complicated and needed to be made accessible
The written information even when accessible needed to be supported with a prompt phone call a couple of days beforehand to remind people about their appointment.
Past experiences – fear and anger of people with learning disabilities and occasionally a family carer needed to be discussed at the beginning of the appointment to ensure success.
The GP practice did not know who their patients with a learning disability were; therefore the systems at the Learning Disability services had to provide an initial list.
This initial list was then built on by the IT department who ran a check on all Read codes that could possibly relate to people with learning disabilities e.g. learning difficulty and mental retardation, emotional difficulties.
Lack of resources at the practice – a Resource Box for Learning Disabilities was completed by the Community Nurse.

Key Messages

Big achievements in a small space of time with very little time demand on the general practice
The clinics are making a difference – health improvements
The practice nurse has developed skills through working in partnership with the learning disability nurse and this has meant that the plan for 2007 is to run them alone.
Shared learning – communication, consent, sexuality and clinical skills have improved the skills of both the practice nurse and learning disability nurse.
Supports the policy drive “Our Health, Our Care, Our Say” for more preventative health care that is joined up and near to the patients home.
Everyone who came to the clinic said they would come back
Economically this is a wise thing to do, as checking people out and treating health conditions in primary care should reduce the amount of referrals to acute hospital settings.
Joint working between the practice nurse and the community learning disability nurse has been fabulous.