GP Tutorial 3 - Learning Disability Flashcards
What should be discussed in a medication review?
Sometimes people aren’t always able to take all of their medications as it can be difficult. I just need to know what you are taking to form a plan, is that ok?
* Medication on
* When taking?
* How much taking?
* Difficulties?
* Any side effects?
How to do a health action plan?
- Formulate patient problem list and formulate action for each one and who should manage it
- Can fill it out on table
- Biopsychosocial approach
Strategies to help consultation with someone who has learning disabilities
- Appointment adjustements - longer slot, morning or afternoon to suit them
- Having carer/family present may help communication
- Specialist nurses may be helpful
- Slowing pace of appointment - smaller chunks info, speak to patient
- Give opportunity for patient to ask questions
- Consider seeing alone if ?safeguarding concern
Areas to consider in holistic assessment of someone with learning disabilities
- Medical - conditions, understanding, meds review
- Social - ADLs, safeguarding, who supports? work? diet?
- Psychological - coping? support? anxiety/depression
- Caregiver - is mother able to provide level of care she needs? Are they well educated in conditions Debbie has
Assessing safeguarding concerns
- Physical exam
- Assess behaviour - withdrawn? fearful?
- Check previous notes - any previous concerns or inconsistencies, not attended appts
- Ask about home life
- Assess carers behaviour and observe dynamics
- Speak 1 to 1 with patient
Decision maker for people with LDs - options
- Patient - if they have capacity
- Lasting power of attorner or deputy appointed by court of protection
- Best interests decision
- Independent mental capacity advocates can help patients make decisions if no friends/family available
5 principles of MCA 2005
- Everyone has right to make their own decisions and has capacity unless proven otherwise
- All practical help must be given before someone is treated to not have capacity
- People have the right to make unwise decisions or eccentric
- Anything done on behalf of someone who lacks capacity must be done in their best interests
- Decisions shouldn’t restrict the freedom of someone lacking mental capacity more than necessary
How do we assess capacity?
2 part test
1. Diagnostic test - is there an impairment or disturbance in the functioning of Debbies mind/brain - eg LD, MH disorder, substance misuse, brain injury)
2. Functional - does this impairment mean they cannot understand, retain, weigh up, and communicate their decision
Types of abuse and signs
- Psychological - enforced social isolation, preventing choice/opinion
- Neglect - not being brought to appts or missing medications, unkempt
- Physical - bruises/injuries, malnutrition signs
- Sexual abuse - bruises on thighs/buttocks/arms/neck, STI/genital infections, reluctance to be with one person
- Financial - missing possessions, family show unusual interest in assets
- Discriminatory - against protected characteristic
- Modern slavery
What options to ensure someone is safeguarded?
- Safeguarding lead at GP practice appointed
- Safeguarding adults boards - report concerns to them, co-ordinate responses in the area
- Involve independent advocates
- Legal aspects - advise about ?deputy via court of protection, report to police if immediate harm
- Voluntary organisations - Mencap, Citizens advice
- Ensure access to community services
- Technology based - personal alarms, monitored bank accounts
- Regular healthough checks - if they don’t attend - f/u with call or home visit
- Educate patients on signs of abuse and what to look out for
6 principles of safeguarding
- Empowerment
- Prevention
- Proportionality - respond in least intrusive way
- Protection
- Partnership - work with organisations
- Accountability - everyone involved with that person is responsible
What is ‘High value care’?
- Healthcare that balances clinical benefits with costs and potential harm
- Provide the most benefit to patients relative to their costs
- Eliminates unnecessary treatments and ensures good outcomes
How do we decide what is funded on NHS?
- Evidence based criteria
- Local funding bodies (eg NHS wheelchair services) - have certain criteria
- Clinical assessments - determine severity and benefit of interventions
- Alternate options have been considered
Who decides what is funded on NHS?
- NHS clinical comissioning groups - allocate resources based on local need and priorities
- MDTs assess individual cases
- Input from carers and advocacy groups
Ethical concepts that guide decisions around funding
- Justice - fairly distribute
- Utility - maximise benefits with resources
- Equity - resources allocated to underserved/areas that need it most
- Accountability for reasonableness - ensure that decisions are clear, relevent, revisable and enforcable
- Prioritarianism - greater priority given to those worse off/in greater need
- Proportionality - proportionate to need
- Sustainability.- consider long term impacts to ensure system remains effective and accessible for future
Responding to conflicts with funding
- Acknowledge
- Discuss resource allocation
- Explain funding decisions - not made by me specifically
- Explore alternatives
- Offer to reassess eligibility if things change
