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 …