Learning disability Metrics 8.01, 8.02 and 8.03
David Hamilton is the Health Facilitation lead for Tees, Esk and Wear Valleys NHS Trust (working in South Tees locality) – he has worked as a learning disability nurse for the past 15 years after working briefly as a general nurse. He has worked for the past 2 years as a Health Facilitator within a small team ensuring people with learning disabilities have access to health action planning and improved access to health care.
Jan Emmerson is Health Facilitator in the same Trust for the Stockton locality where she has been in post since November 2005, prior to which she supported people in a community home and worked as a community nurse.
David Hamilton set out to engage GP practices in addressing the health needs of people with learning disabilities. This was an area that he had been involved in when he first took on his health facilitator post but had achieved only limited success.
Initially he asked the PCT to write to all the practices explaining his role and that he would be contacting them. Following this, David contacted all practice managers requesting a slot at their practice meetings to discuss improving services for people with LD.
Many practices did not have regular meetings and it was often difficult to access those that did have meetings. He also gave each practice an information file containing syndrome specific information, accessible leaflets, details of learning disabilities services etc., which some staff said was useful. For the practices where he was unable to attend a meeting he arranged a contact with a practice nurse or practice manager. David used the meetings to discuss some basic issues: what was meant by a learning disability, health problems, health action plans and learning disability registers.
David also started the process of writing to the GP of everyone he had contact with either directly or indirectly (through care homes/agencies) to highlight that they had a learning disability and advise appropriate Read code. Each person was also advised to arrange a health check and discuss their health action plan with their GP/Practice nurse.
Jan’s experience as a health facilitator to date has not been as straight forward as she originally thought! But she has already been instrumental in ensuring that around 75% of GP practices within Stockton area have developed their LD register. One GP is keen for his practice to take the lead and begin clinics specifically for adults with learning disabilities with Jan and their practice nurse.
At present her role is split between different “levels” of health facilitation – strategic level working with managers; with GPs and other Primary Care staff developing registers, looking at setting up health clinics and improving access to their services; within men’s and women’s group’s, looking at various health topics and organising guest speakers; and still working individually with people, and in residential homes etc.
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David found that Social Services data were not being made available to Health as the learning disability service was not an integrated one. Most people with a learning disability accessing services are known to social services.
However key people in social services felt that it would breach confidentiality to share personal details without individual consent. The data was to be used to help GPs know their patients with a learning disability and would have been a quick way to help create LD registers.
The compromise reached is that each person is asked if they want a health action plan at a social services review, their details sent to David accepting or refusing, he can then write as appropriate to their GP to state that they have a learning disability.
Other barriers encountered:
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Low priority by GP practice agenda to needs of people with leaning disabilities
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Large number of local GP practices to engage by one person
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Significant amount of time to complete thorough health assessments
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Limited knowledge by GPs of issues for people with learning disabilities
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Jan’s past experience of supporting individuals both in a residential home and as a community nurse has been of great benefit, giving her the chance to understand how the reception arrangements and standards of health care received by people with learning disabilities compare with those of other people.
A major factor in causing change to occur was the change in the GP contract to include the development of learning disability registers. This prompted many practices to contact David for help and some practices then proactively called up patients with a learning disability for health assessments.
It was evident as practices developed their registers that this process was easier for some due to the letters that David had sent earlier being acted upon.
Linking health assessments to other QOF indicators (e.g. mental health and epilepsy) made it easier for GPs to see how they could benefit from improving contact with people with learning disabilities.
Another important factor was being able to identify people with an interest within practices who could facilitate change.
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For some people access problems were identified and electronically flagged on their notes to assist with appointments.
For those people attending health checks many unmet health needs were identified such as anaemia, thyroid problems, diabetes, hypertension, wax in ears, vaccinations due, medication changes needed, cervical screening. These issues in many cases were then addressed.
For some practices there was an increase in awareness of the number of people with learning disabilities locally, an understanding of learning disability issues, and raising the profile of the local specialist learning disability service.
Improved joint working with some practices resulted including a project working together on health assessments, communication skills and on practical aspects of working with people with learning disabilities through forums, time out sessions, and one to one support.
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Identify local allies and champions in Primary Care
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Identify motivational levers, e.g. by helping practices with their registers you can learn what is important to them.
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Ensure that the work is a two way process: Practices are more likely to take on extra work if they can see how it can benefit them.
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As a health facilitator, be prepared to start from the beginning – explain who you are aiming to support within the term “learning disability”.
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Remember that the health facilitator role is the key link, but by involving users it will be possible to truly address how and where improvements should be made.
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