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With reference to the letters following and original article by Mike Fitzpatrick,1 I find it hard to believe that our own patients' experience could be so very different to those in the study GPs' populations. I would agree that there may well be access difficulties to many of these patients, as there are to those with mobility problems, or indeed those who simply live away from good public transport and do not drive, albeit difficulties of a different nature and solutions. There will also be those for whom certain types of services will pose specific obstacles, such as the mentioned smear programme. I cannot claim we are offering a perfect service to all, but then perfection would mean none of our patients were ever ill anyway, which clearly we don't achieve for any group of patients.
However, we see patients with learning difficulties in surgery far more often than the figures quoted. We have a good number of patients with learning disabilities who consult on their own, with some finding their own way to the surgery, and others making their own appointments.
It might be interesting to see if we consult with them disproportionately on days we have open surgery rather than appointments. (We have ‘phone-up-and-be-seen’ surgeries every morning, and some evenings, but ‘turn-up-and-be-seen’ surgery on Wednesday afternoons and all branch surgery sessions).
We are only a small practice with three partners and 4500ish patients, but I would estimate we see patients with learning difficulties most weeks. We would therefore be reluctant to drag every single one of them in for an annual MOT solely because they had a learning disability. We prefer to treat them as normal patients, making allowances where necessary in the same way as we would for a deaf, blind, or arthritic patient. Some we see regularly, some we never see because they are healthy many of our ‘other’ patients we see only every 20 years or so if they remain well!), and some do not wish to see us.
Some patients with learning difficulties are under ongoing care from specialist teams, in which case we probably would have little to add to their specialist care, although we would still be happy to see them where they had an independent GP problem.
Perhaps the difference lies in the fact that we see them more as ordinary patients, some of whom have individual needs or allowances or peculiarities, rather than as a ‘problem group’. I suspect there might be something in the fact that if a patient presents with a chest infection, I treat them, and code the attendance, as for a respiratory problem, not a learning difficulty, even if one co-exists. Have our patients become so mainstream that their learning disability is not noticeable, and they function satisfactorily? I am thinking that is perhaps what we should be aiming for after all, not sticking them with different labels? Again, maybe the same is true for many other GPs and so that is why the statistics appear to show that no one ever sees them. If the learning disability is stable, it does not need any changes in the treatment plan, and therefore is not coded as a reason for consultation.