SCIE Research briefing 2: Access to primary care services for people with learning disabilities
Published April 2004
Updated April 2005
Introduction - What is the issue?
Defining 'learning disability' is a complex and contentious issue. Recent policy defines learning disability as "a significantly reduced ability to understand new or complex information, to learn new skills with a reduced ability to cope independently which started before adulthood, with a lasting effect on development". However, this may not resonate with learning disabled people's self-definition or that of their families. People with learning disabilities (PLD) experience higher rates of ill health and have more complex health needs than the general population, including epilepsy, dental problems, mental health and behavioural disorders and nutritional disorders. In addition to these difficulties, PLD have problems in accessing primary health care. Access is made more difficult because of communication difficulties and barriers in encounters between health professionals and PLD and practical issues such as long waiting times and lack of consultation time. This can result in a failure to access primary health services such as men's and women's health screening, cervical screening, genetic screening, dental checks and treatment and health promotion. Basic health problems may be unidentified or regarded merely as part of the learning disability rather than a medical problem.
What are the implications?
Research in this area focuses on the involvement of specialist health care staff, particularly the community learning disability nurse, multidisciplinary working, the need for regular screening programmes/health checks and medication reviews that are acted upon, and more support/recognition for the carers' of PLD. There is also a need for more and better information, better appointment systems to reduce waiting times and communication skills development across all staff in primary care. Professionals, such as GPs and practice nurses need specialist skills training (particularly communication) in this field .
"Valuing People" details specific targets and deadlines in relation to PLD to increase health care access and reduce inequalities. Recent research also emphasizes the importance of specialists to co-ordinate care for PLDs, and to facilitate their access to mainstream primary care. Furtherresearch is needed to identify the long-term clinical effectiveness of health checks for PLD and the experiences of PLD themselves in accessing primary health services such as walk-in centres and NHS Direct.