Skip to main content

Quality Checking Health Checks for People with Learning Disabilities: A way of finding out what is happening locally

Annual health checks for people with learning disabilities have been a key part of NHS plans to improve health and reduce premature mortality since 2008.

Evidence suggests that annual health checks (AHCs) are effective in identifying unmet health need. Conditions identified include serious and life threatening illnesses as well as more minor health conditions. There is also evidence that health checks are effective in prompting health actions to address identified health needs. Surgeries providing AHCs have been shown to make more referrals to primary and secondary health services. NICE guidance on mental health and people with learning disabilities explicitly recommends annual health checks.

This Enhanced Service (ES) is designed to encourage practices to 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 check action plan. Although most requirements of the Enhanced Service have remained unchanged since 2015/16, in 2017/18 the payment for the Learning Disabilities Health Check Scheme increased to £140 per health check, and a new National electronic health check template has been developed by NHS England for practice use if they so choose. These changes are part of an overall strategy by NHSE to increase the number of health checks delivered. Related initiatives include updated guidance from the Royal College of GPs which follows the new template, guidance developed by Mencap for people with learning disabilities and families, and guidance and associated film developed for social care providers. The Royal College of GPs has updated their guidance and it follows the new template.

Since the scheme started the numbers and coverage of reported AHCs have continued to rise, although direct comparisons with previous years are difficult because the data collection processes and eligible age group have changed. Data shows that 52% of eligible patients had an AHC in 2014/15. The proportion of GP practices participating in the Enhanced Service has increased. However there is substantial variation across the country and approximately one in seven people with learning disabilities is registered with a practice that does not appear to be offering AHCs.

This brief audit tool is an update of one published by the Learning Disabilities Observatory (then known as IHaL) in 2011. It is designed to support practices, primary care liaison staff, health facilitators and others to improve the uptake and quality of annual health checks (AHCs) and thereby reduce the health inequalities experienced by people with learning disabilities.

The audit tool (based on six simple questions) can be used by GP practices and those providing support to GP practices to:

  • identify good practice and encourage services to improve their practice further
  • establish whether health checks and primary care services are provided consistently across a geographical area
  • monitor progress
  • embed key ‘reasonable adjustments’ within primary care

For five of the questions, there are three levels of success; bronze, silver and gold. Bronze is the basic level and includes the minimum requirements needed to meet the Enhanced Service specifications. There is also a column listing suggested evidence which auditors may find helpful to gague the performance level. The evidence in this column is not intended to match up to specific items in the columns to the left.

The results of undertaking the audit do not imply endorsement by any external organisations or bodies.

There is an easy-read version of this report available at