Learning disabilities

Learning disabilities was a clinical priority for the RCGP from 2010-2012 in recognition that people with a learning disability are not getting equal access to healthcare.

These resources are designed to support GPs and the primary healthcare team to care for people with a learning disability and to encourage equal access to healthcare.

Annual health checks for people with learning disabilities - step by step toolkit

This guide is aimed to help primary care provide high quality annual checks for people with a learning disability. It was produced by the RCGP Clinical Champion for Learning Disability, Dr Matt Hoghton, and the RCGP Learning Disabilities Group in 2010.

Learning Disabilities Mortality Review (LeDeR) programme

The LeDeR programme has been commissioned by NHS England and it is now a requirement for health and social care services to review all deaths of patients with Learning Disabilities aged 4+ in England, as part of the national framework for Learning from Deaths
There are two specific ways that GPs and Primary Care teams may be required to contribute to the LeDeR Programme:
1. By notifying the deaths of patients with learning disabilities aged 4 years and over to the LeDeR programme.
2. By providing information to inform a review into the circumstances leading to the death of a person with learning disabilities. All deaths receive an initial review; those from which it is felt that further learning could be taken receive a full multi-agency review.
The legal basis for sharing patient identifiable information is provided by approval from the Secretary of State under section 251 of the NHS Act 2006 to process patient identifiable information without the patient’s consent (Reference: 16/CAG/0056The GMS Confidentiality Guidance(Clause 105) advises that doctors may disclose relevant information about a patient who has died where disclosure is authorised under section 251 of the NHS Act 2006.
The LeDeR programme strives to ensure that reviews of deaths lead to learning which will result in improved health and social care services for people with learning disabilities. It is not an investigation nor is it aimed at holding any individual or organisation to account. If individuals and organisations are to be able to learn lessons from the past it is important that the reviews are trusted and safe experiences that encourage honesty, transparency and the sharing of information in order to obtain maximum benefit from them.
More detailed information about the review process, and other aspects of the LeDeR programme are available on the LeDeR programme website


Over-medication, and then lack of review, is a historic problem, but one that nobody knew the true scale of until recently. It is estimated that on an average day in England, between 30,000 and 35,000 people with a learning disability are being prescribed powerful drugs, with serious potential side effects, without clinical justification and for too long. This is often despite evidence-based alternative interventions being available.

This inequality in care is unacceptable, and it is incumbent on clinicians and every other professional involved in an individual’s care to ensure they are acting in their patient’s best interest at all times.

Welsh Health Check template for adults with a learning disability (2016)

This is the updated version of the original Welsh health check and the Welsh Health Check 2 developed by Professor Mike Kerr and colleagues.

It is designed to support primary care doctors and nurses to provide a systemic physical health check including physical examination, medical review and health check action plan. It will take approximately 1 hour to complete and is a free resource.

Vision and people with learning disabilities: Guidance for GPs

This guidance aims to support GPs and primary healthcare teams to identify sight loss and visual impairment in their patients with learning disabilities and to signpost them to appropriate specialist services. The guide was produced by the RCGP in collaboration with the Royal College of Ophthalmologists and SeeAbility and was launched in June 2012.

RCGP Mental Capacity Act (MCA) toolkit for adults in England and Wales 2011

This toolkit is designed to provide information and support for the application of the Mental Capacity Act to GPs and primary care staff.

Commissioning guide

The RCGP, along with the Royal College of Psychiatrists and the Learning Disabilities Observatory has produced 'Improving the Health and Wellbeing of People with Learning Disabilities: An Evidence-Based Commissioning Guide for Clinical Commissioning Groups (CCGs)'. The guide was produced in 2012 and is designed to provide practical support to CCGs, with Local Authorities and Learning Disability Partnership Boards, to commission health services in ways that achieve better health outcomes for people with learning disabilities in a challenging financial climate.

Resources and tips for commissioners, service providers and health and social care staff


Learning disabilities is the focus of nine modules in e-GP that reflect the RCGP curriculum. Access to e-GP is available free of charge to all UK NHS general practitioners, GP speciality trainees and GP educators.

To access go to the eGP website.

RCGP Curriculum on learning disabilities

Dr Peter Lindsay is curriculum guardian and regularly reviews the undergraduate and postgraduate curriculum for inclusion of learning disability subjects.

RCGP Curriculum Statement on Care of People with Learning Disabilities 

RCGP learning disabilities group

The group is chaired by Dr Jill Rasmussen and aims to represent GPs from all parts of the UK to ensure the highest standards of care for people with a learning disability.

For further information, please contact Dr Matt Hoghton on matthew.hoghton@rcgp.org.uk.


What is the National Audit of Learning Disabilities - Feasibility Study (NALD-FS)?

The National Audit of Learning Disabilities - Feasibility Study began in May 2013 and finished in April 2014. This work was commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP). The Royal College of Psychiatrists led the study and RCGP, through the Clinical Innovation and Research Centre (CIRC), had responsibility for the primary care aspect of the study. The study aimed to determine:

  1. whether a national clinical audit could feasibly generate reliable data about the quality of care provided by health organisations to people with learning disabilities.
  2. whether a national clinical audit is an effective way of driving improvement within NHS organisations.

The feasibility study included a small number of primary and secondary care sites (general acute and mental health). The pilot sites were based in South Wales, Lancashire, London, and Nottinghamshire. In primary care, information about patients were extracted from GP systems. Secondary care sites were asked to gather and report back information on: reasonable adjustments; physical and mental health assessments; staff training; improved communication with patients and carers; and other issues relating to the health care of people with learning disabilities.

Every participating site received a local report which benchmarked their performance against other sites taking part in the audit.

Learning Disability review of feasibility study and future plans

Results of the Learning Disability Clinical Audit Feasibility Study have now been published. Results of the feasibility study (involving 12 GP practices, nine acute hospitals, and seven mental health services across England and Wales) indicate that the quality of care for people with learning disabilities falls below recommended standards.

In primary care, there was reported to be a low uptake of annual health checks, unsatisfactory physical health monitoring and health promotion. Secondary care services were found to have difficulty identifying people with learning disabilities. Learning disability was not included in mandatory training programmes and some staff reported feeling out of their depth when caring for this patient group.

NHS England has welcomed the feasibility study – commissioned by HQIP and carried out by the Royal College of Psychiatrists – and outlined how it will support work such as the Learning Disability Self-Assessment Framework. However NHS England has taken a decision to proceed with a National Learning Disability Mortality Review, rather than a clinical audit.

NHS England national clinical director for learning disability Dr Dominic Slowie recognised the good work of the feasibility study, stating that it ‘has a number of useful findings about methodologies to be applied in any future clinical audit of the care for people with a learning disability’, and that NHS England believes collecting reliable data on healthcare experiences and outcomes for people with a learning disability is ‘key to improving outcomes for them’.

He added that NHS England would also incorporate insights from the feasibility study into the ongoing development of the Learning Disability Self-Assessment Framework. Dr Slowie said: “We will require all hospitals to audit reasonable adjustments to care as part of the standard contract from 2015 and are working with the CQC to establish review of care for people with learning disabilities in all settings as part of their new inspection regimes.”

However, he also pointed out there have been a number of developments since the feasibility study was first commissioned (in 2012), particularly the  Confidential Inquiry into the Premature Deaths of people with Learning Disabilities (CIPOLD) report in 2013. This Inquiry was funded by the Department of Health and recommended the establishment of a national review of the causes of death in people with a learning disability.

“Against this context, NHS England does not intend to establish a clinical audit at this time but has committed to establishing a learning disability mortality review drawing on the valuable insights this feasibility study demonstrated,” Dr Slowie said.

Further information about the Learning Disability Mortality Review will be available in due course on the HQIP website.


Confidential inquiry into premature deaths of people with learning disabilities

The confidential inquiry was funded by the Department of Health with the aim to improve the health and well-being of people with learning disabilities by carrying out an inquiry into their death. Dr Matt Hoghton, former RCGP Clinical Champion for Learning Disability was a key member of the inquiry.

For all information, including the final report and the Department of Health's formal response go to CIPOLD.


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