New Directions
Joint Learning Difficulty Service
Salford
Primary Care Trust
Accessible
Well-Person Checks
Report into the introduction of well-person checks
for adults with learning difficulties in Salford.
Cath Rotherham
Healthcare Facilitator (Learning Difficulties)
August 2006
1
New Directions
Joint Learning Difficulty Service
Salford
Primary Care Trust
Accessible Well-Person Checks
Report into the introduction of well-person checks for
adults with learning difficulties in Salford.
Report Prepared by: Cath Rotherham (Healthcare Facilitator – Learning Difficulties)
Report Prepared for: Andrew Clough (Director of Nursing and Risk Management - PCT)
Dave Clemmett (Head of Service – Joint Learning Difficulties Team)
Margaret Anderson (Professional Lead – Practice Nurses)
Date of Report:
11.8.06
Introduction
It is known that people with learning difficulties have high levels of health care needs but have
difficulties accessing primary care services which can result in conditions going undiagnosed
and/or untreated. There are many reasons cited for this including people with learning
difficulties (or their carers) not recognising the signs of ill health, accessibility problems,
confusion over consent and diagnostic overshadowing, which is described by the NPSA as,
‘overlooking symptoms on the assumption that they are part of the persons learning disability’
(NPSA 2004)
The failure to obtain timely treatment for health conditions can then result in more difficult to
treat symptoms or even hospital admissions that could have been prevented. This may go some
way to explain some of the health inequalities that we know exist for this client group. Health
inequalities such as preventable deaths being four times higher and only 20% of eligible
women receiving a cervical smear as opposed to 80% of women in general.
One way of addressing this situation is to provide a comprehensive health check for this client
group. This pro-active approach will provide primary care staff with an opportunity to provide
health tests as well as general health promotion.
This report describes the piloting of an accessible well-person check and the amendments made
to it following its evaluation.
The Drivers for Comprehensive Health Checks (supported by accessible information)
1) Once a Day (NHS 1999)
Stated that GP Practices should, ‘encourage and support people with learning disabilities and
their carers to attend well woman/well man and screening clinics…’
Furthermore, the guidance pointed out that, ‘regular health checks should ensure that the need
for community health services is detected and acted upon’.
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2) National Patient Safety Agency (NPSA 2004)
The Patient Safety Priorities :– Understanding the patient safety issues for people with
learning difficulties
The NPSA identified five priority areas, of which three can be partly addressed by the
introduction of an accessible well-person check. These are:
Swallowing Difficulties:
‘Problems associated with eating and drinking can be life threatening for people with
learning disabilities. They can lead to poor nutritional status, dehydration and aspiration
that can lead to chest infections, a leading cause of death among people with learning
disabilities’(NPSA)
Lack of Accessible Information:
‘Harm may result if a person with a learning disability is unable to understand
information relating to illnesses, treatment or interventions’. A particular concern also
noted was, ‘Healthcare professionals not having the resources to explain treatment or
care in accessible ways.
Illness or disease being miss or un-diagnosed:
‘Access to treatment is often delayed because symptoms are not diagnosed early
enough. This could lead to undetected serious health conditions and avoidable deaths’
The other two recommendations from the NPSA’s report relate to the ‘Inappropriate use of
physical intervention (restraint)’ and the ‘Vulnerability of people with learning disabilities in
general hospitals’. Indirectly the well-person check can also address these two areas as, for
example, behaviour of a challenging/aggressive nature may be related to undetected pain or illhealth.
3) Treat Me Right–better healthcare for people with a learning disability. Mencap (2004)
This report recommended Primary Care Services should proactively identify peoples’
health problems by offering annual health checks to all people with a learning
disability. The report supported the idea of accessible information being provided in all
healthcare settings, and identified that 70% of GPs did not have accessible information
in their surgeries.
4) Disability Discrimination Act (1995)
A principle of this act is that organisations should make ‘reasonable adjustments’ to
ensure that people with a disability are not excluded from services and do not get worse
services than people without a disability’
5) Signposts for Success
This report stated, ‘there is emerging evidence that routine health checks can lead to the
identification of previously unrecognised health problems in people with a learning
disability. Early identification can prevent the development of more serious problems
and produce long-term benefits.
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6) You Can Make a Difference:- improving primary care services for
disabled people (NHS 2004)
In looking at adjustments to policies and practices this report suggests, ‘providing
annual health checks to groups who are at high risk of physical ill health, such as
people with mental health problems or learning disabilities.
7) The National Care Standards (2000)
These standards state that ‘all people with a learning disability living in residential care
should receive an annual health check’.
8) Improvement Expansion and Reform – Ensuring that All Means All
(Valuing People Support Team 2003)
This report urges PCTs to specifically consider how they will include their learning
disabled population in their mainstream work otherwise they will continue to be
excluded and ‘all’ will not mean ‘all’.
9) Better Metrics (2006) – Measurable objectives for Primary Care Services
In the data PCTs collect the Better Metrics lists:
% of Learning Disabled Patients offered a comprehensive health check.
It also identifies that, ‘People with Learning Disabilities and their families will be
offered easy to understand information about their health’
10) Salford PCT’s Six Pledges
Accessible well-person checks are in line with the 6 pledges, particularly:
Pledge 1 – Protect People and help everyone enjoy longer healthier lives.
Pledge 2 – Provide better and more services.
Health Action Plans / Health Facilitators (Department of Health 2002)
In addition to the above drivers it is important to mention the link between accessible wellperson checks and Health Action Plans / Health Facilitators.
Health Action Plans (HAPs) are individual health plans written for people with learning
disabilities. The purpose is to identify health actions that will make a positive difference to the
health and well being of the individual.
The idea of Health Action Plans was recommended by the Department of Health in their white
paper ‘Valuing People’ (2001). They also recommended that each individual with a learning
difficulty should be given the opportunity to have a Health Facilitator – this being someone
who could help the person with their health needs; especially navigating around the various
health services available.
In Salford over 400 adults with learning difficulties now have health facilitators and health
action plans. In developing the plans the person is supported to visit a wide range of health
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professionals dependent on their particular needs – such as dentists, opticians, dieticians,
psychiatrist etc. A health facilitator would also look to arrange a well-person check for the
person they support.
A recent audit with the health facilitators identified that the uptake of routine health
appointments is concerning. The audit identified that many people with learning difficulties do
not seek support with basic health issues such as smoking and dieting. In addition the uptake of
cervical and breast screening tests was also poor.
In providing an accessible well-person check the Practice Nurse has an opportunity to check
with the person (and their health facilitator if present) that these basic health issues are not
being overlooked.
Designing the Accessible Well-Person Check
In designing the well-person check it was important too ensure that it was compatible with the
I.T computer systems presently in operation within the GP Practices in Salford, these being
Vision and Emis. To achieve this the template was designed with the support of Carol Hart
(Quality Manager).
The reason an I.T. compatible template was needed was to enable any information gained as a
result of the well-person check to be ‘read coded’ instantly. Read coding is when health
conditions are given a specific code which enables Practices to identify groups of patients with
particular conditions. It also enables Practices to identify trends as well as the number of
patients with particular conditions who attend their Practice. The read codes assist in providing
follow up care for those with long-term conditions or any condition where regular monitoring
is recommended. The use of read codes is a national system – which provides health
information to the Department of Health for future planning of budgets and services. Read
code evidence is also used for GP Practices in the QOF (Quality and Outcome Framework)
reviews – the outcome of the QOF review being one of the factors related to financial
payments for GP Practices.
Paper versions of well-person checks are easier to produce but when completed the results of
the health consultation can easily be overlooked as paper copies become filed away. Paper
copies can be logged onto the computer systems following the consultation – but this requires
additional time which is of a premium within busy GP Practices.
A further reason to have an I.T compatible system is that the present health check templates,
for example for patients with Coronary Heart Disease (CHD) or Diabetes, are all designed in
this way. This keeps the template familiar to the Practice Nurses who will be implementing it.
There were a number of reasons for designing the well-person check for use by Practice
Nurses, rather than a comprehensive health test to be carried out by the GP. In the main a
patient with a health worry will visit the GP – often supported by their carer. However, for
those who do not recognise the signs or symptoms of ill health, or who have little carer
support, the well-person check can identify health problems (or potential problems) and treat
accordingly. The Practice Nurse is well placed to carry out this role, and can refer the patient
onto the GP where needed.
Another factor in the design of the template was to keep it as similar to the present well-person
checklist as possible. In addition, the accessible template needed to include those health needs
that we know to be problematic for people with learning disabilities. The key was to get a
balance to ensure it covered the main health concerns without being too lengthy or
cumbersome.
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Prior to designing the draft template I spent time with two Practice Nurses to look at their role
and the type of consultations they deliver. I examined numerous accessible well-person checks
that other regions have adopted and looked at their merits and limitations. I also discussed the
initiative and obtained advice from Margaret Anderson, who is the Professional Development
Lead for Practice Nurses.
One of the main decisions taken in putting the draft well-person template together was to make
it general rather than syndrome specific. To make the template syndrome specific would have
meant designing numerous versions. Instead, the template covered the main health areas but
Practice Nurses were provided with a paper document which detailed those additional health
tests that they should consider if the patient has a known syndrome.
The final well-person template which the Practice Nurses piloted included the following areas:
Diagnosis
Mobility Issues
Communication Assessment
Sensory Assessment (eg vision and hearing)
Skin Assessment
Medication
Basic Examinations (BP, weight, urine testing etc)
Sexual Health (eg due smear test)
Oral Hygiene
Lifestyle (eg smoking, drinking, diet / swallowing difficulties)
Continence
Health Promotion (eg alcohol, smoking
Referrals (record of any referrals made as result of consultation)
Health Action Plan (Practice Nurse writes, in simple words, her recommendations)
Recall (if needed)
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Piloting the Well-person Checklist
A group of 100 individuals with learning difficulties were identified who were either able to
consent to having a well-person check or for whom it was in their best interests. The wellperson template did not contain any health tests, questions or treatments that would not
normally be offered by Practice Nurses so the piloting of the template did not fall into the
category of research.
The Health Facilitators for the 100 individuals were also identified. Health Facilitators being
the person (normally a paid carer) who takes a lead on supporting the person with their health
needs.
Practice Nurses were approached to inform them of the initiative, then in due course the
Practice Nurses for the 100 individuals were approached to see if they would pilot the
template. In approaching the Practice Nurses individually it provided an opportunity to explain
the rationale for an accessible well-person check. It also provided an opportunity to address
any initial concerns such as issues around consent.
The pilot group included individuals with a wide range of health care needs, this being to
ensure a representative cross section was chosen. The pilot group were also chosen so that
most Practice Nurses would only be piloting the template with one or two individuals. This
was important to prevent any one Practice Nurse being expected to allocate a dis-proportionate
amount of time to the initiative – as well as to ensure that enough Practice Nurses used the
template to make the evaluation results meaningful.
Following the identification of the individuals and the Practice Nurses, the next stage was then
to visit the Practice Nurses to load the template onto their computers and explain the template
to them. This visit was completed by myself and a member of staff from the Data Quality
Team. In addition to explaining the template, the Practice Nurse was provided with a Guidance
Pack which contained the following:
A copy of the accessible invitation letter – to be used to invite those on the pilot group in
for the well-person appointment.
A selection of accessible handouts / leaflets that the Practice Nurse could give to the
individual or their carer during the consultation. Leaflets on smoking, diet, cervical smears,
breast screening, diabetes etc
Purchase and order details for other accessible handouts / leaflets
Information on consent.
Information on syndromes and the additional health checks needed.
A selection of accessible pictures that could be used to progress the consultation eg pain
chart.
A blank copy of a Health Action Plan (HAP) – to be used if the patient or their carer did
not bring along their own HAP documentation.
(HAPs are documents that can be used by the Practice Nurse to record any
recommendations from the well-person check. The advantage of the HAP being that the
patient has a written record to refer to which they can share with their carers as needed)
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Information booklet for Practice Nurses on cervical and breast screening for women with
learning disabilities.
Information from the National Patient Safety Agency (NPSA) and Mencap related to the
healthcare needs of patients with learning disabilities.
Contact details for ‘New Directions’ (Salford’s Joint Learning Difficulty Service). This
incase the Practice Nurse felt the need to seek further advice or services for the individual.
Contact details for obtaining further supplies of free leaflets printed by the Department of
Health.
The Guidance Pack was explained to the Practice Nurse before an electronic version of the
pack was loaded onto their computer. The electronic guidance pack can be easily updated as
new leaflets / information can be emailed directly to the Practice Nurse for inclusion in their
folder.
Following the visit to the Practice Nurse – a final email was forwarded to them to confirm the
name of the individual(s) to invite in for the well-person check.
EVALUATION RESULTS
The Practice Nurses were provided with an evaluation form to complete following each wellperson check. The results of the pilot are as follows:
Section 1 (Numbers involved in the Pilot)
A total of 50 Practice Nurses at 23 Practices were originally involved, these being linked to the
100 individuals identified to be in the pilot group. Of the original 23 Practices:
2 x Practices had to be removed from the pilot as they had older version computer
systems which were not compatible with the template.
1 x Practice wanted to defer involvement owing to QOF Pressures.
1 x Practice constantly failed to respond to phone-calls / messages.
1 x Practice did not want to offer the well-person check to those individuals who could
not give their own consent to the appointment.
2 x patients moved out of Salford, and were therefore removed from the pilot group.
This resulted in 14 patients being removed from the original group and 9 patients being
deferred to a later date. This reduced the number of patients in the pilot group from 100 to 77.
The well-person template was therefore offered to 77 patients.
42 evaluation forms were returned (54%)
Of the 42 returned forms:– 31 patients had turned up for the appointment and 11 patients had
not turned up for the appointment. The reasons added to the evaluation form to explain the
non-attendance included:
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1 x patient was in hospital (has regular health checks owing to his diabetes)
1 x patient had to cancel as carer (sister) could not get the time off work to accompany
to the appointment.
1 x patient’s mother declined the invitation as she reported that he will not
communicate or comply with any interventions.
Flow Chart (numbers involved in the pilot)
31 Evaluated health checks
42 Evaluation Forms returned
14
Declined
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77 well-person checks offered.
Deferred
100 Patients eligible to participate
Section 2 (Where the appointment took place)
29 appointments all took place in the Practice Nurses room at the GP Practice.
2 appointments took place in the patient’s own home.
Section 3 (Average length of time of the appointments)
The longest appointment was 60 minutes duration
The quickest appointment was 15 minutes duration
The average appointment time was 32 minutes duration
Section 4 (Number of Health Facilitators / Carers in attendance)
29 x patients were supported to the appointment.
2 x patients attended alone.
Section 5 (Number who brought their HAP form)
18 x patients brought their HAP form
13 x patients did not bring a HAP form
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Section 6 (Number of Practice Nurses who added their recommendations onto the HAP)
12 x patients had their HAP form completed by the
Practice Nurse.
13 x patients were given health actions to follow but
they were not written onto the HAP form by the
Practice Nurse.
6 x patients did not have any health actions identified
by the Practice Nurse.
(NB: The nurses had blank HAP forms incase the patient forgot to bring theirs to the
appointment)
Section 7 (Alterations to Template)
10 x Practice Nurses felt that some alterations that were needed to the template.
9 x Practice Nurses felt that no alterations were needed to the template.
12 x Practice Nurses left this question blank.
The alterations / comments recorded were as follows:
Health Promotion for smoking / diet.
Well-person concerns – to cover menstruation and contraception.
Smoking status to be added.
Alcohol consumption.
BP / Weight
Sexually active rather than impotent.
Continence assessment – should include occasional accidents.
Attends dentist regularly.
Patient visually impaired – none of the options fitted.
Section 8 (Syndrome Specific Checklist)
1 x Practice Nurse referred to the syndrome specific checklist.
20 x Practice Nurses did not need to refer to the syndrome specific checklist.
5 x Practice Nurses recorded that this was ‘not applicable’ for their patient.
5 x Practice Nurses left this question blank.
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Healt h act ions
recorded on HAP
Healt h act ions not
recorded on HAP
No healt h act ions
ident if ied
Section 9 (Health Issues)
Sensory Assessment
22
Skin Assessment
Health Actions
recommended
9
Referral made
20
Accessible
leaflet / info
given
Communication Assess.
Advice given.
7
Left Blank
24
Not Applicable
Known concern
present
Mobility
New Concern
identified
No concerns
identified
The following matrix details the number of patients for whom a particular health issue applied,
and the resulting actions.
1
1
2
1
2
7
2
3
26
3
2
2
Medication review
26
1
2
2
5
Exam Findings
25
1
5
1
1
Test Results
17
1
4
9
1
1
Sexual Health
27
2
2
Oral Health
21
8
2
3
Lifestyle
18
9
4
12
1
Continence
20
6
2
3
5
1
Health Promotion
17
4
1
9
7
4
4
1
2
3
1
3
A patient was referred to the GP for his hip problem.
Communication Assessment
A patient was referred to the optician (home visiting service)
A patient was referred to the GP for referral on for a hearing test.
A carer was given advice on how to recognise if hearing was impaired.
11
1
1
2
6
1
The specific comments and actions (where recorded by the Practice Nurses) related to the
above numbers are as follows:
Mobility
4
3
6
Sensory Assessment
A patient was referred to audiology as the patient was concerned about hearing loss.
A patient was referred to the GP for referral on for a hearing test (patient had an appointment
for ear syringing.
Two patients were referred to the optician (home visiting service)
Skin Assessment
A patient had a new concern identified related to skin care as incontinent.
A patient was advised to use oilatum in bath due to dry skin.
A patient was provided with cream following new concern identified.
Medication Review
A patient had a new concern identified related to constipation. The patient was given advice on
OTC (over the counter) medications for constipation.
A patient was referred to the GP as their medication needed to be reviewed.
Exam Findings
Two patients would not cooperate with investigations eg Blood Pressure test.
A patient had a slightly raised blood pressure – the advice given was to lose weight and
increase exercise.
Test Results
A patient had their bloods taken and the support worker was told to ring for the results. The
Practice Nurse could not confirm if concerns present or not until blood results returned.
A patient would not allow the Practice Nurse to take the bloods.
A patient would not cooperate with any tests.
Sexual Health
A patient had a new concern related to the use of condoms. Advice was given on condom use
and condom failure.
A patient had a new concern – having recently been diagnosed as pre-menopausal.
A patient was given advice and an accessible leaflet on TSE (Testicle Self Examination)
Oral Health
A patient had a known concern related to difficulty getting an NHS dentist.
A patient had a last dental check 18 months ago – the patient was advised to go for a dental
check which the carer will organise.
A patient has dentures but does not use them.
Lifestyle
A patient was given advice and an accessible leaflet on BSE (Breast Self Examination)
A patient was given advice on their chocolate intake.
Two patients were given advice on smoking cessation.
A patient was given advice on diet / exercise – though was very reluctant to take the advice –
but the carers constantly encourage.
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A patient was encouraged to continue with their low fat diet.
Continence
A patient had a new concern identified – the Practice Nurse has requested a MSSU(mid stream
sample of urine) to exclude a UTI (urinary tract infection) then will review.
A patient had protein present when the urine sample was tested (sample was then sent to
Pathology but no infection present).
A patient had a known concern of chronic constipation – advice was given about increasing
fibre and fluids.
A patient had medication commenced.
A patient was give advice about drinking plenty of fluids.
A Practice Nurse will test for protein & glucose if concerns / symptoms arise.
Health Promotion
Two patients were given advice to increase exercise.
A patient was given advice about reducing the fat in their diet.
A patient was given advice on menopausal symptoms.
A patient was given an accessible leaflet on cervical screening.
A patient was given an accessible leaflet on breast examinations.
A patient was encouraged to carry on with their weight loss.
A patient was given advice on stopping smoking – but the patient refused to even consider
stopping.
Section 10 (Any Other Comments)
9 x Practice Nurses provided the following additional comments:















The carers forgot to bring HAP but will put concerns into plan on return.
Quality of information dependant on carer’s knowledge of patient.
No formal assessment of risk of sores due to continence problem.
This lady lives with mum – carer has no other input from social services.
Inappropriate consultation. Patient unable and unwilling to communicate / participate.
Complete consultation conducted 3rd party via carer.
Seen regularly for reviews/updating action plan.
Already brought in regularly by carers for reviews/updating action plan.
Type 2 diabetes. Appointment given for fasting blood test and urinalysis.
Template quite cumbersome to go through compared to other templates we have on
system for other conditions eg diabetes / CHD.
Could be easy to miss some areas of the template out because of the format.
Inappropriate consultation. Patient unable to communicate and demonstrate
understanding. Needs met by carers. Assessment carried out via carers.
The patient seemed to enjoy the consultation – sister wanted to answer on the patient’s
behalf but with good eye contact and encouragement the patient participated well.
First time doing this – did not find it easy. More training sessions would be a good
idea.
Didn’t have a HAP – did have a record of all related concerns though.
Brought HAP but not sure on how to use it.
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Constraints to Project.
The introduction of this, as with any other new initiative, put time pressures on Practice Nurses
and the Practice Staff. This competed with other time pressures that the Practice Nurses were
involved in - such as preparing for QOF reviews.
There were concerns about ‘consent’. It is a difficult area even for those professionals who
work with the Learning Difficulty Services. The assumption was made that all Practice Nurses
would adopt the ‘best interest’ principle when offering the well-person check to patients who
could not give their own consent. This assumption was incorrect – and resulted in a number of
patients being withdrawn from the pilot group.
The role of ‘Health Facilitator’ is new. A good consultation with the Practice Nurse will often
be as a result of an informed Health Facilitator being present and proactive. Many Health
Facilitators will only just be getting accustomed to their role.
The provision of a ‘Health Action Plan’ is a new document – again its purpose and function
may not be clear to all Health Facilitators or Practice Nurses.
The Practice Nurses who used the EMIS computer system were disadvantaged in that it does
not have the capacity for linking / drop down menus to the degree that the VISION computer
system does.
The well-person check was only evaluated from the perspective of the Practice Nurses.
Including the patients and the carers / Health Facilitators would have resulted in more
comprehensive findings.
Evaluation results show unnecessary overlap between ‘Communication Assessment’ and
‘Sensory Assessment’.
SUMMARY
During the health checks a total of 15 new concerns were identified, which resulted in 4 new
referrals. In addition the Practice Nurses provided advice on 45 issues, gave out 10 accessible
leaflets and recommended 31 health actions for the patients involved. In view of the number
of patients seen (31) this equates to half of the patients having a new health concern picked up.
Main Outcomes of well-person checks
Practice nurse actions
30
25
Patients
20
15
10
5
50
45
40
35
30
25
20
15
10
5
0
Health issues
(advice provided)
0
New concerns identified
Referrals made
14
Health actions
recommended
Leaflets given
The pilot is timely as the DRC (Disability Rights Commission) have just launched their report
following a formal inquiry into the health inequalities faced by people with learning disabilities
and/or mental health problems. The report: Equal Treatment – ‘Closing the Gap’ recommends
annual health checks for people with learning disabilities (recommendation 9) as they
recognised that a pro-active approach to health care is essential for the early diagnosis and
treatment of health conditions that otherwise may go untreated.
Finally, making available an accessible well-person check will also be in line with the new
Disability Equality Duty (DED) that comes into force in December 2006. This duty requires
PCTs to actively promote disability equality, as opposed to avoiding ‘disability discrimination’
which can still result in unintentional exclusion.
RECOMMENDATIONS
1. Review and agree alterations to the template (in line with evaluation results) along with
two Practice Nurses who were involved in the Pilot.
2. Carol Hart (Quality Manager) to reformat template in line with agreed alterations.
3. Write to all G.P’s / Practice Nurses to inform them of the existence of the new
template, detailing the merits of including it on their computer systems. Suggest that the
template could be used either:
When a patient presents for a well-person check.
Opportunistically.
To target patients with learning difficulties who fall into high-risk groups.
To target patients who have not visited their GP within the last 3 years.
(NB: Targeting patients with learning difficulties will be a realistic option when the GP
Practices have established their learning disability registers – using Read Codes)
4. Work with Quality Manager to agree timetable for loading new template at all GP
Practices.
5. Review the template with regards to EMIS computer systems.
6. Monitor guidance from the Department of Health related to comprehensive health
checks / well-person checks – ensuring that Salford are in a position to respond.
REFERENCES
Department of Health (2001) Valuing People: A new strategy for learning disability for the 21st
century. London. The Stationary Office.
Department of Health (2002) Action for Health: Health action plans and health facilitation.
London. The Stationary Office.
Department of Health (1999) Once a Day, London, NHS Executive.
Key Highlights of Research Evidence on the health of people with learning disabilities:
Institute for health research at Lancaster University.
Mencap (2004) Treat Me Right:- better healthcare for people with a learning disability.
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Disability Rights Commission (2006) Equal Treatment: Closing the Gap – A formal
investigation into physical health inequalities experienced by people with learning disabilities
and/or mental health problems.
FURTHER INFORMATION / CONTACT DETAILS
For further information on the contents of this report contact:
Cath Rotherham
Healthcare Facilitator (Learning Difficulties)
Salford PCT
St James’s House
Pendleton Way
Salford
Tel:
0161 212-4590
Mobile: 07801-928011
Email: catherine.Rotherham@salford-pct.nhs.uk
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