Learning disability registers: known unknowns and unknown unknowns

The call to the government to prioritise COVID-19 vaccinations for all people with learning disability (LD) has featured in the mainstream press recently. This campaign was in response to evidence published by Public Health England (PHE) over 8 months into the pandemic, that highlighted the disproportionately high COVID-19 mortality rate within the population of people living with LD.¹ The advice that followed was that GPs should use their clinical discretion when deciding to prioritise vaccinations for patients with LD on their lists.² Some clinical commissioning groups committed to prioritising all patients with LD known to them³ before the Joint Committee on Vaccination and Immunisation decided to recommend this approach, recognising that the severity of LD may not be documented in GP records.⁴ Alongside this press coverage, the lack of fully comprehensive GP registers for patients with LD slipped briefly into the limelight. The challenges of this have been discussed within BJGP before.^5,6 Maintaining an LD register is incentivised by the Quality Outcomes Framework (QOF).⁷ In 2017/2018, NHS England (NHSE) increased the financial incentive for undertaking annual health checks for those on a practice’s LD register.⁸ The number of patients on this register acts as a target when completing annual health checks and now weighs into …