Following assessment most people with a learning disability can be placed into a low, moderate or high-risk group.
The following areas should be considered when deciding whether a person needs to have a priority face-to-face or a less urgent, virtual annual health check.
- clinical history
- current comorbidities including medication
- recent trauma or contact with services
- support for daily living.
Local systems may want to use a red, amber or green approach to deciding who they see face to face and who may receive a virtual annual health check.
People who are ‘red’ (or most clinically at risk of health deterioration in the year or with the most complex medication etc.) should be called for their annual health check first and this should be face to face wherever possible.
Most people will need a face-to-face review so that they can be physically examined. It is important however to consider the risks and benefits of each face-to-face appointment for people with a learning disability.
Lower risk groups
For people who are in moderate and low risk groups doctors can consider the use of remote appointments.
These should only be offered to people who feel able to have an appointment in this way and where a physical examination is not needed for the review. Before the appointment a pre-check questionnaire should be sent to the person’s home for them to fill in.
Risk assessment examples
- Low risk (green) – Peter is 41 years old and lives on his own with an extensive social care package. He is generally fit and well but has regular issues around constipation. He manages his medication and is considered stable although he still has some episodes of constipation. Peter would be given a pre-check questionnaire to complete with his carer and then have a remote appointment. If a clinical concern was flagged up in the pre-check questionnaire or during the remote review then a further face-to-face appointment would be needed.
- Moderate risk (amber) – Jay is 27 years old and lives in a care home with 24/7 support. Jay has dysphagia and is in the moderate group. A remote review will take place unless anything is flagged by the pre-check questions.
- High risk (red) – Alex is 57 years old and has type 2 diabetes, anxiety and a history of epilepsy. He usually manages his conditions well and enjoys his independence. His care package has been stepped down in the last few years to support his growing independence. Alex is in the high priority group. The pre-health checks should still be done, but it is important that Alex comes for a face-to-face review.