Clinical audit of annual health checks for patients with learning disabilities at a GP practice in rural South Warwickshire

Abstract

Introduction: Annual health checks (AHCs) improve access to primary healthcare services for people with learning disabilities. People with learning disabilities (LD) have been shown to have poorer health outcomes than the neurotypical population (Mencap, 2016) (Heslop A, 2013). AHCs increase identification of previously undiagnosed health conditions (Robertson J, 2010). Shipston Medical Centre has a LD prevalence of 0.45%- lower than the national average of 0.53%. (NHS Digital, 2021). This audit investigated the uptake of AHCs by people with LD at a rural GP practice and compare with the national average and NHS England target.

Methods: The standard used was: “At least 75% of young people and adults over the age of 14 with a learning disability should have had an Annual Health Check in the last 12 months.” (NHS, 2021) The practice learning disabilities register identified all patients >14 years old with registered LD, and EMIS was used to search for their most recent AHC.

Results: Of the 50 patients at Shipston Medical Centre eligible for an AHC, only 34 (68%) of them had attended an AHC in the last 12 months- lower than the national average of 74% and NHS England target of 75%. Of the 16 patients who had not had an AHC in the last 12 months: 8 patients (16%) declined an appointment, 3 (6%) did not arrive at their agreed appointment time, 3 (6%) were awaiting bookings, and 2 (4%) were not invited.

Discussion: Limitations to the AHC system at this practice included fixed appointment times, practitioner inflexibility, 30-minute limits, and lack of reasonable adjustments. These limitations conflict with Public Health England recommendations and may contribute to poor AHC engagement. Subsequent recommendations included increasing staff training, greater appointment flexibility, and longer appointments. A re-audit should occur after implementation of these changes to assess for improvement.