Why all GP practices need a learning disability specialist

Lord Paul Scriven, a Liberal Democrat member of the House of Lords, has spent years championing the rights of people with learning disabilities. Speaking with Madeleine Anderson, he discusses what must change to improve access to specialist care in primary care settings and why more learning disability nurses (RNLDs) are needed in general practice.

Why is LD nursing so important to you?

‘There is a very specialist nature to the conditions and service provisions which are required by learning disabled people. By not having specialist support in primary care, this will unfortunately lead to poorer health outcomes for these people.

‘And that’s why learning disability support must be seen as part of the mainstream of care, whether that’s in an acute setting, a community setting, or a primary care setting.

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‘Specialist learning disability support must not be seen as an add on, it should be seen as something that’s central to a well-developed care team for the needs of a population.’

Are you concerned about the state of LD nursing in England?

‘We’re seeing a fall in registered learning disability nurse numbers and I think it’s very worrying. And if this continues, people with learning disabilities will continue to have poorer health outcomes and not be given the specialist support that they vitally need.

I think there’s a real opportunity to provide more specialist learning disability care, particularly in primary care.

‘I think the GP Contract needs to be looked at on this, and that a greater emphasis and greater monitoring of specialist support, alongside greater funding, is needed to ensure that learning disability services, including learning disability nurses, are appropriately encouraged and funded in primary care.

‘So, I think there’s a lot that the government can do, and I think some of it’s contractual, some of it’s cultural, and some of it is financial. But it’s clear to me that this trend can’t continue if we’re serious about improving learning disability health as a nation.’

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Why is it important that specialist care is delivered in general practice?

‘General practice really hasn’t got the infrastructure behind it to support healthcare professionals to read and understand learning disabled patients correctly. General practice professionals are very busy, and they are generalists, but as part of their team they need somebody that’s got specialist training to provide the correct and adapted care for people with a learning disability when they come in. Specialists in primary care can work to ensure annual health checks are carried out, that reasonable adjustments are made on an individual basis and that wider teams act appropriately when supporting each patient.

‘That’s why it is absolutely vital, because for most people their first point of contact with healthcare is not secondary care but primary care. And that’s why getting that care right really matters, and having learning disability nurses as part of a primary care team is definitely part of that.’

In June, Nursing in Practice exclusively reported that England could run out of its domestic supply of RNLDs by 2028.

In October, we published a series of exclusive interviews with RNLDs working in general practice who shared how having their specialist role in practice had improved annual health check outcomes and saw more patients attend sometimes life-saving health screenings.

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That same month, Mencap led a coalition of leading charities, campaigners and health organisations writing to the health and social care secretary to voice concerns over the ‘imminent collapse’ of learning disability nursing and the subsequent risk to people with a learning disability.

Data from NHS England (NHSE), published in December 2024, showed that 79.6% of patients with a learning disability had an annual disability health check. This was down slightly from 79.8% in the year 2022 to 2023, but an increase compared to the 2021 to 2022 period (71.8%).