The Learning Disability GP – Building a service in learning disability medicine
27 September, 2023
Dr Maria Vincent (GP Specialist in Learning Disability Medicine, Clinical Fellow Learning Disability Psychiatry (Swansea Bay University Health Board), GP Partner Vale of Neath Practice, Glynneath) talks about the role of a GP in the learning disability team.
I work in Swansea Bay University Health Board as a GP Specialising In Learning Disability Medicine. This is a part time post, alongside my other part time role as a Learning Disability Psychiatry Clinical Fellow. I work 6 sessions a week in total for the Learning Disability Service across these roles and I am a 6 session partner in General Practice alongside this. This makes for a very busy week, but I would not have it any other way.
I entered Medical School with a burning interest in Neurology, which started in my early teens, when I read Oliver Sacks’ book Awakenings. However nerdy that sounds, the book spoke to me, and it quickly became a firm driver behind my pursuit to get into medical school. Like Sacks, I wanted to see the potential in the seemingly hopeless. I wanted the opportunity of challenge, the uncertainty of the unknown. The appeal was helping those not fully understood by the medical profession and, so often, left without a voice.
I graduated from Bristol University in 2011, with MBChB (Hons) and an intercalated BSc Neuroscience (Hons, 2008). I qualified as a GP (MRCGP) in 2016.
I did not want to leave my interest in neurology behind. I did, however, adapt it. I wanted to be a physician, but not within the constraints of a hospital, rather as a generalist in the community, understanding people in their social context, their family units, and through the lens of their individual lives.
Nothing provided this experience better than the experiences of my patients with Learning Disabilities. These individuals and their families present an eclectic group of varied potential, illness, comorbidities, communication challenges and complexities. To support these patients requires a myriad of skills. One must accept uncertainty, try new things, be patient, be prepared to be wrong and be able to vary and adapt one’s clinical approach to history, physical examination and physical contact within the patient assessment.
I have never in any other part of my work been more challenged, rewarded and delighted. To work with individuals with Learning Disabilities is the privilege of my life.
The current role
Within the learning Disability Team, I have taken a lead role in the management of medical issues which arise for patients being supported by the team.
I am often assigned patients to see, who have concurrent mental health and epilepsy disorders. My role is multi-fold.
I support the provision of Learning Disability Psychiatry Services by holding clinics for new patients and follow up, referred to the Psychiatry team for the diagnosis and management of mental illness, as well as the assessment and management of epilepsy and seizure episodes.
I have developed skills in the assessment of mental health in this heterogeneic group, and I have gained a good deal of knowledge in the assessment, diagnosis and management of seizures.
However, my own role extends beyond this. I am asked to assess patients when there is uncertainty over the role of physical health issues in epilepsy and psychiatric presentations. I see patients in clinic, online and at home and contribute community medical expertise to the Multi-disciplinary team.
The problems seen range from the everyday workload of the General Practitioner (cough, constipation, reflux, skin problems, infection), to the complex and specialist (including the longer term physical sequelae of rare genetic disorders).
I travel all over South Wales, seeing patients in residential settings, day service, clinic and at home.
I have developed a good practical relationship with our nursing team and local General Practices. I have additionally learned the difficulties faced both by primary care and the secondary care sector in the management and transfer of communications between settings and I think this has made me a more effective and patient General Practitioner.
I have utilised the opportunity through this role, to extend my psychiatry expertise. I gained a Postgraduate Diploma in Clinical Psychiatry (Distinction), University of South Wales in 2022 and have used the knowledge gained not only in the diagnosis and management of patients with Learning Disability, but in the day to day management of my patients in General Practice. I have also enrolled In the International League Against Epilepsy Academy and am undertaking training modules in the management of epilepsy.
Through this role, I am more confident in the understanding of specialist drug prescribing in the areas of psychiatry and epilepsy and have gained a good knowledge of appropriate drug monitoring, which make me a more confident prescriber. In addition, I am more resourceful in the management of instances in which patients require altered medication routes and preparations.
This role has given me opportunity to be involved in the planning of complex medical procedures and in the assessment of individuals with very challenging behaviour. I am skilled in the assessment of people who struggle with physical contact, have complex autism or are easily overstimulated. These situations have made me a much more alert and attentive clinician, something that I can take back to General Practice.
In this role I have taken opportunities to teach, as well as contribute to medical literature and to give advice within the context of a research group.
With this in mind, I can firmly say that my opportunities and career have taken off in recent years and I have markedly extended my influence and the difference I can make within the Learning Disability Team, as well as within General Practice.
I cannot recommend enough the creation of a portfolio based career. My one role feeds the other. I maintain my focussed decision-making, balancing uncertainty and rapid assessment skills as a GP, but I also have the ability to delve deeper and sometimes even enter unchartered territory within the ever-evolving world of Learning Disability.
My role is constantly extending. I provide the medical input for Swansea Bay’s complex health clinics and I have recently taken on the role of the clinical lead for the restructuring of Complex Health Needs Services within the Health Board. These additional roles have helped me develop my understanding of services in the context of management. These very much compliment my position as a GP Partner, who his involved in clinical and managerial decision-making processes.
People with Learning Disability have health needs that differ from those of the ageing population. It is my own view that they require an adapted and person centre approach, which reviews their health issues in the context of their individual needs, conditions and stage in the ageing process. As people with Learning Disabilities age and reach ever older chronological age, there will be an increasing need for expertise in their management. I do not think this is catered for in the current models of hospital and General Practice and I strongly believe that a specialist Learning Disability Medicine service is required as a medical subspeciality in its own right, ideally comprised of community based generalists who have gained expertise in health conditions associated with Learning Disability, Complex Needs and specific genetic syndromes.
There is a marked lack of these skills currently in the UK. I want to use my own experience to develop a Learning Disability Medicine department in South Wales. This will act as a tertiary service, which receives referrals to assess patients from the Learning Disability Team, looking at physical health issues in adults through the ageing process, as well as physical causes for challenging behaviour, mental health presentations and seizures.
This project remains very much in its infancy. However, I have always believed every journey starts with a single step. In the coming decade I will be working to increase my medical expertise, specifically pertaining to general medicine and the management of complications of genetic causes of learning disability.
I am in the process of trying to increase my time spent giving medical based physical health advice within the learning disability team and in increasing the area over which my services are available.
I will be working towards additional specialist accreditation in the area of Learning Disability Medicine.
It is an exciting prospect and just goes to show how diverse any medical career can be, if you want it to be.
What would I say to others?
I encourage others to be curious about the roles open to them. I would stress that Learning Disability Psychiatry, Epilepsy and Medicine are some of the most interesting and unexplored areas of clinical medicine today, with boundless opportunities to help people and families, as well as learning more about the complexities of neurology, the functioning body and the way it adapts to adversity.
I would tell others to find the beauty in the difficult, the potential in the complex and the reward in the journey.
I want to put forward the idea that as individuals we have a lot more control over our careers than we first understand after leaving training. There is room in medicine for creativity, flexibility and to really make a lasting difference. All you need to do, is work out what gets you out of bed in the morning and base your life on this. For me, this is Learning Disability and the medicine around it. In picking an area that is less established within medicine, I have been able to make my own niche.
I encourage everyone else to do the same, find what you love doing and fit this into your life. It’s not work if you enjoy it.
Dr Maria Vincent, GP Specialist in Learning Disability Medicine and Clinical Fellow in Learning Disability Psychiatry