Having a learning disability nurse involved in the organisation and delivery of annual health checks at general practices for people with a learning disability can help to improve uptake, a trial suggests.

 

The project saw learning disability nurses from Kent Community Health NHS Foundation Trust (KCHFT) work in partnership with six local surgeries to test a new model of annual health checks.

The trial, which took place at the start of 2020, was due to last for 12 weeks but had to be cut short due to the coronavirus pandemic.

However, the trust said the results from the pilot were still positive and that the project had since been adapted and extended, with a second trial launched.

Under the new model, appointments are extended so that patients have 40 minutes with a KCHFT learning disability nurse and then 20 minutes with the GP.

Becky Hankin, the senior community learning disability nurse from KCHFT, explained: “Mostly, we handed patients over to the GP and supported them to feedback the key issues that had arisen while with us and any actions already agreed, for instance, onward referrals, so this could be included in their health action plan. If the patient wanted us to stay with them, we would.”

The nurses also advised the surgeries to send patients an easy-read letter about their appointment beforehand and ensured easy-read information was available at the clinics themselves.

Ms Hankin said the nurses would also phone patients ahead of appointments to talk them through any worries or concerns they may have had.

“We also found phoning and speaking with patients before their appointments, to let them know what would be involved, reduced [do not attends],” she told Nursing Times. 

She said assessment questions for the appointments were also adapted into a format that was simpler and better helped to uncover any underlying health issues.

“We found this brought up quite a few questions about the menstrual cycle and menstrual cramps; we were then able to get the person the medicine or help they needed,” noted Ms Hankin.

“Other issues which came up a lot were dental care, looking after ears and nail care.

“We also made quite a few mental health referrals, for anxiety and bereavement, with our pilot happening during the lockdown.”

When Covid-19 took hold, three of the six surgeries involved in the pilot had to cancel their adult health check clinics as they were unable to provide face-to-face appointments.

However, the project team still managed to achieve an increase in checks for all six practices collectively, from 22% to 48%.

The three surgeries that continued to provide the annual health check clinics during the pandemic completed checks with 93-100% of their learning disability patients.

Nationally the uptake target for annual health checks is 75% of eligible adults with a learning disability. However, in 2018-19, the figure achieved was only 43%.

The other nurses on the project team from KCHFT are Lisa Harrington, specialist community matron in learning disabilities, and Chris Hunter, senior community learning disability nurse.

Ms Harrington said: “The project’s aim was to increase the uptake and quality of annual health checks for people with a learning disability.

“We achieved this by working with GPs, people with a learning disability and their families and carers.

“We focused on increasing awareness and understanding about the benefits of the annual health check and making sure information was accessible.”

She told Nursing Times: “This project highlighted that the specialist expertise, knowledge and skills of the learning disability nurses working with the GPs, can help improve the assessment process of the annual health checks and overall positive health outcomes for people with a learning disability.”

One GP involved in the pilot, from Bethesda Medical Centre, Margate, explained how, previously, health checks were undertaken by GPs with their patients.

However, there was “no set structure to the consultations and no record of outcomes”, noted the GP.

With the new model in place, patients were getting a “much better service”.

“Feedback from patients, carers and GPs has all been very positive and patients and carers feel much better supported by the LD nurses and the surgery,” they added.

Due to the success of the pilot, the trust is now working with five GPs in a second project to trial the service, using the same model, with a KCHFT learning disability nurse supporting annual health check clinics.

From January to March 2021, the trust has supported 176 annual health checks. Of these, 49% resulted in patients, their families and carers receiving advice to support their care needs and 32% generated a referral to the trust’s learning disability team, including people who had not previously been known to the service, according to KCHFT.

During the pandemic, learning disability nurses across the UK have also led the way in designing and implementing accessible Covid-19 vaccination clinics for people with a learning disability, as reported by Nursing Times. 

 

SOURCE: Nursing Times