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Meeting the learning disability DES targets

Dr Jeremy Phipps explains the systems his practice has developed to meet the requirements of the learning disability directed enhanced service.

When the learning disability directed enhanced service (DES) was announced, there seemed good reasons for our practice to be involved.

The service, initially commissioned in England only, is aimed at supporting patients with learning disabilities and in particular monitoring their physical health. 

The preponderance for physical health problems in this patient group was well known and the balance between care by specialist psychiatrists and GPs was a role we had already undertaken. 

What we were already doing

In keeping with national policy, patients were transferred from a large long-stay residential hospital into small units covered by our practice. We also cared for a number of patients with learning disabilities in specialist care homes for those with deaf-blind problems through the charity Sense. 

Having read through the initial information on this new service we were keen to express an interest. Much of the work required was really a more formalised recording of care that we were already providing.

We were extremely fortunate in the standard of care provided for patients in these homes. I regularly marvel at the care and patience exhibited by their staff. 

Patient lists

The first requisite for the DES was the production of a list of eligible patients. For the majority of patients this was a simple task as many were living in specialist care homes.

Other patients, particularly those still living with their families, were less easily identified. The disease registers were of some benefit but there were coding issues with some confusion between entries for learning disability and difficulty. 

Following a combination of computer records, information from local social services departments and personal knowledge of practice staff, we were able to compile a list which was quickly agreed with the PCT. 

Maintaining this list is relatively straightforward, ensuring new registrations are included and also as only patients over 18 are eligible, adding those as they attain this age. 

Patient care

A further requirement was that at least one doctor and one practice nurse attend a training session to educate us on the relevant areas of health screening we should include. This was organised as a joint PCT/social services session.

Much of the screening is appropriate for all patients, for example smoking, vaccinations, weight etc, but patient group specific areas are included such as dysphagia, constipation and potential iatrogenic problems from prescribed medication.

Having completed the training the clinical information that was necessary to record was included as a computer template. Most of this is completed opportunistically during the year as patients attend for routine appointments or from home visits. 

There is always additional information that has not been completed and this is reviewed annually, usually in February, by one of our nursing staff.

Carers are contacted, usually by phone, to allow fuller record completion and where necessary patients are invited to attend or visited for further screening.

In retrospect, although few new clinical problems have been identified, the learning disability DES does seem to be a service that carers in particular appreciate. This formalisation of clinical care supports a good working relationship.

  • Dr Phipps is a GP in Lincolnshire

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