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Learning disabilities enhanced service requirements 2017/18

A summary of what is involved in the learning disabilities health check scheme ES for England.

The only change to this ES from 2016/17 is the payment for each health check. This has increased from £116 per patient to £140.


Identify all patients aged 14 and over with learning disabilities, to maintain a learning disabilities 'health check' register and offer them an annual health check, which includes producing a health action plan.


For 1 year from 1 April 2017. Practices are required to sign up to this service within 42 days of being offered the ES by their commissioner.


£140 for each patient aged 14 and over on the practices agreed learning disabilities register who receives a compliant health check. Payment is quarterly, but only one payment can be made per patient across the financial year.

Service requirements

  • Establish and maintain a learning disabilities ‘health check register’ of patients aged 14 and over with learning disabilities, based on the QOF learning disabilities register and any patients known to social services.
  • Practices must attend a multi-professional education session – training is mandatory for any new practices wanting to take part in this ES.
  • All patients on the health check register should be invited for an annual health check and have a health action plan.

The register

  • Practices should liaise with local social services to identify people with learning disabilities who may not be on the QOF register.
  • If it is not possible to agree a current register with the local authority, practices are permitted to use the previous year’s register – this must be agreed with your area team.
  • Practices have to confirm the number of patients on the health check register for payments to be calculated on CQRS.


  • Training should be provided by your area team or CCG – this should be provided as required.
  • It should be completed by health professionals before health checks are undertaken.
  • As a minimum the practice's lead GP for learning disabilities, lead practice nurse and practice manager/senior receptionist should attend a training session.
  • The training should cover an understanding of learning disabilities; identifying patients and clinical coding; understanding the increased health needs of this group; what an annual health check should cover; what is involved in a health action plan; overcoming barriers in consultations and physical access; collaborative working with carers; families and social services; consent; the Mental Capacity Act; the Equality Act; and local resources that are available.

Health checks

Practices should invite all patients on the health check register for a review of physical and mental health annually. As a minimum the health check should include:

  • A collaborative review with the patient and carer (where applicable) of physical and mental health including: health promotion, chronic illness and symptoms enquiry; physical examination; epilepsy, dysphagia, behaviour and mental health and specific syndrome check
  • Accuracy and appropriateness of prescribed medication checked
  • A review of co-ordination arrangements with secondary care
  • A review of transition arrangements (where appropriate).
  • A review of communication needs
  • A review of family and carer needs
  • Support for the patient to manage their own health and make decisions about the health and healthcare

Practices should use a suitably accredited protocol agreed with the area team – eg the Cardiff health check.

Health action plans

  • These can be created at the time of the health check via an electronic template or provided to the patient as a written plan following the review. NHS England is developing a new template for this, but it is not mandatory to use this template. This template should be available from July 2017.
  • Practices need to ensure the plan is provided in the best possible format for the patient to maximise their understanding.
  • The focus of the plan should be the key action points discussed and agreed in the health check.
  • It should highlight any other relevant information.
  • If the patient has a personalised care plan in place, this should form part of the health action plan.
  • If a patient is mentally competent to provide their consent the health action plan should be shared with other relevant professionals.


Practices have to manually input data into CQRS every quarter. There are two inputs

  • ES indicator LD001 input number: The number of those patients aged 14 and over in the financial year on the practices agreed learning disabilities register who received a completed health check in this quarter.
  • ED indicator LD001 maximum: The number of patients aged 14 and over in the financial year on the practices agreed learning disabilities register.

CQRS will calculate the quarterly payment based on achievement data either entered manually via CQRS or data collected by GPES when this is possible.

Read and CTV3 codes

Diagnostic codes

  Read v2 Read CTV3
Mental retardation E3...% E3...%
[X] Mental retardation Eu7..% Included in E3...%
[X]Developmental disorder of scholastic skills, unspecified Eu81z Eu81z
[X]Mild learning disability Eu816 XaREt
[X]Moderate learning disability Eu814 XaQZ3
[X]Severe learning disability Eu815 XaQZ4
[X]Profound learning disability Eu817 XaREu
On learning disability register 918e. XaKYb
Specific learning disability Eu818 XaaiS
Significant learning disability


Health check codes

   Read v2  Read CTV3
Learning disability health examination*  69DB.  XaPx2
Learning disabilities annual health assessment*   
9HB5 XaL3Q
Learning disabilities health action plan completed
Learning disabilities annual health assessment declined
 9HB6.  XaQnv
Learning disabilities health action plan reviewed  9Hb2.  XaJWA
Learning disabilities health action plan declined
 9HB0.  XaJW9
*Either code will count towards achievement

Further information

You can view the full details on this enhanced service in the technical requiements for the 2017/18 GMS contract changes here.

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