Specialist nurses within learning disability services have been identified and
promoted as a result of the National Health Service and Community Care reforms
(I990), as well as through intensified debate within the learning disability nursing
profession. The Department of Health has further supported the analysis of the
role and the function within the context of the health and social care divide,
promoting practitioners to concentrate on addressing health gain concerns through
the Health of the Nation targets (DOH I995).
It is suggested within this paper that specialist nurses within the community have
not been allowed to develop their professional and philosophical base for practice,
and instead have been manipulated by economics, policy formulation and through
medical and managerial domination.
The philosophy of primary health care is identified as providing these specialist
nurses a framework so as to effectively realize true primary health care, as well as
recognizing the impact that clinical governance will have on ensuring the need for
practitioners to provide evidence-based practice (DOH I997).
Two conceptual models are proposed; a segretative model and an integrative
model, which offer the specialist community learning disability nurse a way in which
the practitioner can work more effectively within the primary health care arena.
Four domains of practice and a preventative crisis intervention approach give the
specialist nurse a clinical foundation, to use within the primary health care setting.
The perceived benefits and potential difficulties of making these models workable
will also be highlighted.
It is recognized that integrating these models locally will be dependent upon how
specialist learning disability services are configured in each locality and how newly
formed primary care groups may include community learning disability nurses, and
how co-opted members are utilized to examine the health needs of people with
learning disabilities.
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