What's New?- June 2017

Following 2gether  (2G) NHS Foundation Trust's new Learning Disability pathways we have worked together  to create this pathway on referral into the Learning Disabilities (LD) Service.

Community LD Services include:

  • Four Community Learning Disability Teams (CLDT's) based in different Gloucestershire Localities. Each is multi-disciplinary comprising Learning Disability Nurses, Occupational Therapists, Physiotherapists, Clinical Psychologists, Psychiatrists and Speech and Language Therapists.
  • The Learning Disability Intensive Support (LDIS) Team  and the Intensive Health Outreach Team (IHOT) are Countywide Teams that work closely with the CLDT. They hold smaller caseloads than CDLT's to allow more time-intense, time-limited support where needed. The former is more focussed towards the support of behavioural/mental health needs while IHOT focuses more on physical health needs.
  • There is also a small Health Facilitation Team that works as part of LD community services to provide a source of accessible information, advice and training around Reasonable Adjustments.

All Teams seek to work closely with mainstream health services as well as the wider support networks for people with Learning Disabilities.

Reviewers are always needed for the Learning Disabilities Mortality Review Programme (LeDeR). Please email leder-team@bristol.ac.uk or telephone 0117 3310686 for further information.

2gether NHS Foundation Trust Learning Disability Pathway Overview

Please click the relevant flowchart box to to be taken directly to textual information


Red Flags
Unexplained change in persons usual presentation or concerns raised by those who know them well
  • consider physical health issue
  • consider psychological issues
  • consider potential of abuse (physical, sexual, emotional, financial, neglect)
  • consider recent changes in support

Definition of learning disability

A person is identified as having a learning disbaility and being eligible to receive a service if all three of the following are present:

  1. significant impairment of intellectual functioning; and
  2. significant impairment of adaptive behaviour; and
  3. onset before adulthood

(The British Psychological Society, 2016)

The person will have significant challenges in general  mental ability which includes reasoning, planning, solving problems, thinking abstractly, comprehending complex ideas, learning quickly and learning from experience. Just over 2.5% of people (determined by reference to a normal distribution within the general population) may be expected to have a general level of intellectual functioning commensurate with a diagnosis of a Learning Disability.

Concerns 'the collection of conceptual, social and practical skills that have been learned and are performed by people in their everyday lives'.

Examples include:

  • Conceptual skills: language; reading and writing; and money, time and number concepts;
  • Social skills: interpersonal skills, social responsibility, self-esteem, gullibility, naivety (i.e. wariness), follows rules/obeys laws, avoids being victimised, and social problem-solving;
  • Practical skills: activities of daily living (personal care), occupational skills, use of money, safety, health care, travel/transportation, schedules/routines, and use of the telephone.

Relative to the general population a person with a Learning Disability has significant difficulties with such activities of daily life

Means there should be evidence of the presence of each of the other two criteria before the person attains the age of 18 years.

Differential Diagnosis

Learning difficulty as opposed to Learning Disability?

Some people have specific learning difficulties which do not result in the depth and breadth of intellectual and other difficulties required for the diagnosis of a Learning Disability. Common example of specific learning difficulties include dyslexia and ADHD. Similarly someone with Autism can have normal high intellectual function combined with problems with social skills- These profiles would not meet the criteria for a Learning Disability.

Health Issues vs Learning Disability

People with a Learning Disability are prone to greater health issues than the general population but there is a history of people with a Learning Disability receiving sub-optimal health care- in part as a result of access issues but also as a result of diagnostic overshadowing. It is important to understand how the individual with a Learning Disability normally presents. Changes from 'their normal' may be indicative of an underlying health concern.

Initial Primary Care Assessment

Communication difficulties and the potential for diagnostic overshadowing when people do use services mean preventative care and health screenings become particularly important in this population.

People who know the individual well can help understand what is usual for the person. They may also help with communication in the assessment phase.

Initial Primary Care Management

As per mainstream population.

When to Refer

The LD Service will work with potential referrers to facilitate appropriate referrals. This could for example take the form of discussion by telephone prior to any referral being made. The service is commissioned to access within 4 weeks and intervene within 18 weeks per the NHS Constitution. It is not an emergency service although efforts are made to be responsive within 2 or 3 days when necessary. If you feel someone needs to be seen urgently please telephone the CLDT in your area to discuss. (See below for contact details)

The Service is open to any adult with a diagnosis of learning disability who:

  • Has clearly defined health needs within the Pathways described that cannot be met by other mainstream health services, including mental health
  • Are Gloucestershire GP registered or funded by Gloucestershire Clinical Commissioning Group and are on the LD QOF Register. (The service also expects to work with people under eighteen where there is needed to ensure appropriate transition into adult services).

Also the Service monitors people with Downs syndrome because Downs is associated with early onset dementia. If someone has Downs syndrome, is not known the the CLDT, and they are aged 30 or over, please alert the Service.

Referrals will be made by GPs or by the Joint Commissioner for Learning Disabilities for patients who have never accessed the service.

Patients who have previously been on the CLDT caseloads can self-refer back into the service/ be referred back by their carer or care provider.

  • people without Learning Disabilities who develop intellectual disability after the age of 18
  • people without Learning Disabilities who suffer brain injury in accidents after the age of 18
  • people without Learning Disabilities but with specific learning difficulties such as Asperger's syndrome, dyslexia, delayed speech or literacy problems
  • people without Learning Disabilities but with complex medical conditions that develop after the age of 18, e.g. Alzheimer's or Huntington's Chorea

  • does the person have no LD but Autism is suspected and undiagnosed? Refer to Autism Diagnostic service via 2gether Contact Centre. Tel: 0800 015 1499. Email: 2gnft.FPCC-Amin@nhs.net. Address: Ambrose House, Unit 4 & 5 Meteor Court, Barnett Way, Gloucester, GL4 3GG.
  • does the patient have a learning difficulty i.e. dyslexia...if so contact local commissioners with a view to spot purchasing required services
  • is the patient suitable for mainstream Mental Health services? If so follow mental health pathways as for any other patient.

  • patients name/DOB/NHS number
  • reason for potential referral
  • educational history/qualifications
  • history of support in home environment and in daily life
  • past medical history
  • annual health check information
  • comorbidities
  • current care plan

Outside of Office Hours for Mental Health Crisis 0800 169 0398


If uncertain please contact the CLDT covering your locality to discuss the potential referral:

North (Cheltenham, Tewkesbury, Moreton)

Leckhampton Lodge, Charlton Lane Centre, Cheltenham, GL53 9DZ

01242 634300

South (Stroud/Cirencester)

Weavers Croft, Field Road, Stroud, GL5 2HZ

01453 563103

West (Gloucester/Newent)

Fieldview, West Lodge Drive, Gloucester, GL4 7XY

01452 894120

Forest of Dean

Colliers Court, Latimer Lane, Cinderford, GL14 2QA

01594 593075
2gether NHS Foundation Trust LD services


The flowchart refers to specialist LD care-pathways. We have developed a number of these for internal use. Current Pathways are named below. Service-users will be allocated to one or more Pathways according to their individual need.

  • Difficulties expressed through behaviour
  • Communication (Speech and Language Therapist)
  • Eating, Drinking and Swallowing
  • Epilepsy
  • Memory Assessment
  • Mental Health/Emotional Wellbeing Needs
  • Mobility and Physiotherapy Management
  • Physical Health Care
  • Postural Management
  • Daily Living
Ongoing Primary Care Management

Annual Health Checks remain a Direct Enhanced Service (DES) that is designed to improve Healthcare for people with LD. The new DES is due to be associated with software that enable the printing off of a Health Action Plan following a health check.

Additional Resources

My Health Book- produced by the Health Facilitation Team. This A5 book is a tool and foundation for producing person centred Health Action Plans making sure all the facts about health are in one place where they are safe and can be easily found.

Hospital and Community Traffic Light Assessment Form- produced by the Health Facilitation Team. It is a grab sheet that can accompany a person with a learning disability into a community or acute hospital, whether planned or emergency admission. It can be kept with a patient's Health Action Plan.

Annual Health Check

Ensuring patients with a learning disability are on the GP disability register will lead to better healthcare outcomes for this often disadvantaged group. Once on the register all those eligible (aged 14 and over) are entitled to an Annual Health Check (AHC)- helping reduce recognised health inequalities.

The new national electronic Annual Health Check (learning disabilities) clinical template has been produced to aid GPs with this enhanced service health check. This template is currently available on EMIS & Vision with plans for System1 to go live during Autumn 2017.

A primary care pathway is currently being developed to assist practices to identify which sections of the AHC a practice nurse can undertake and which should be undertaken by a GP. More information to follow...

Where to find the AHC Templates

1. Emis users: The template is in EMIS Library > Primary Care Templates > Learning Disabilities HCAP. The template is active, the protocol is inactive.

The protocol - To activate the protocol, go into the templates manager and then navigate to EMIS Library > EMIS Protocols > DES Protocols its in as Health Check Action Plan Launch and Print Protocol. Right click on it, select Status and click activate. It will then be available to add to your F12 menu. This way whenever the template is needed, press F12 on the computer keyboard and select Health Action Plan Launch and Print Protocol from the menu. For more guidance please click here.

2. Vision users: For Vision users instructions for downloading templates can be found here.

3. System1 users: Coming soon.

The questionnaire follows NHS England Annual Health Check electronic template now on Emis, System 1 and Vision.

  • Helps patient and care understand content of the health check
  • Identifies any relevant issues prior to attending appointment
  • Allows information to be gathered prior to appointment, which may be otherwise unknown to paid carer accompanying the patient

GP easy read Access needs letter

Pre health questionnaire GP screen 

A summary and overview of the Learning Disability Annual Health Check electronic clinical template (2017)

This document from NHS England provides a content summary and overview of the new National Electronic Health Check template for people with learning disabilities, agreed as part of the GP contract to be initiated from April 2017.

The Royal College of General Practitioners (RCGP) has published the new Annual Health Check Step-by-Step guide in the form of a toolkit. This collects guidance and resources to help GPs, practice nurses and the primary administration team organise and perform quality Annual Health Checks on people with a learning disability.

Please click here to view the Annual Health Check Toolkit.

Annual health checks for patients with a Learning Disability. Please click this link for the full document.


Patient Resources

Please see the Patient & Carer Information & Leaflets section

Resources for Professionals

National Standards

Please see the National and NICE Guidance section

Other Online Resources


Please the Clinician Education section for Podcasts

Pathway Leads

Name Role Organisation Email
Jonathon Cash Head of Trust Psychological Services and Psychological Services LD 2gether NHS Foundation Trust jonathon.cash@nhs.net
Simon Shorrick Strategic Health Facilitator, Learning Disabilities 2gether NHS Foundation Trust simon.shorrick@nhs.net
Crispin Hebron Non-Medical LD Consultant 2gether NHS Foundation Trust crispin.hebron@nhs.net
Jan Hoskins Learning Disabilities Clinical Case Manager Gloucestershire Clinical Commissioning Group jan.hoskins@nhs.net
Iain Jarvis GP Gloucestershire Clinical Commissioning Group iainjarvis@nhs.net
Zain Patel Commissioning Manager, Planned Care, Care Pathways Gloucester Clinical Commissioning Group zain.patel1@nhs.net
Cheryl Hampson Outcome Manager-Learning Disabilities Health Gloucestershire County Council Cheryl.Hampson@gloucestershire.gov.uk

 Reason for Pathway Selection

Following 2gether NHS Foundation Trust's new Learning Disability pathways we have worked together to create this pathway on referral into the LD service. All teams seek to work closely with mainstream services as well as the wider support networks for people with Learning Disabilities.

Completion Date

May 2017

Review Date

April 2018