Reasonable Adjustments Across the Learning Disability Annual Health Check Pathway: A Co-designed Qualitative Study

Background Annual health checks are structured primary care reviews for people on the learning disability register, intended to identify unmet health needs, support preventative care, and reduce health inequalities. Despite this, people with a learning disability continue to experience persistent health inequalities and avoidable mortality. Although reasonable adjustments are a legal requirement to remove barriers to care, their implementation in primary care remains inconsistent. Method Qualitative study conducted in the North West of England, co-designed with patient and public involvement partners. Six workshops with 43 people with a learning disability and two interviews with healthcare professionals were conducted. Data were analysed thematically. Results Three interrelated themes described how reasonable adjustments were implemented across the annual health check pathway. Personal factors centred on communication and autonomy, including whether individuals were spoken to directly and supported in accessible ways. Professional factors related to workforce capability and confidence in recognising and applying reasonable adjustments. Organisational factors reflected systems that enabled or disrupted access, such as appointment booking and follow-up processes. Together, these factors meant that reasonable adjustments were often applied reactively rather than anticipatorily, reducing their effectiveness. Where adjustments were identified, recorded, and reviewed in advance, annual health checks and preventative care were more effectively delivered. Conclusion Reasonable adjustments are not confined to a single point of care but accumulate across the annual health check pathway. Improving access requires a shift from reactive responses to proactive, system-level implementation embedded within primary care.