An estimated 1.5 million people in the UK have a learning disability, according to Mencap. People with learning disabilities are prescribed an average of 5.5 medicines compared to 3.0 for the general adult population, according to NHS Digital analysis — yet they face persistent barriers to understanding their medicines, accessing pharmacy services and being heard when something is wrong. The Equality Act 2010 requires pharmacies to make reasonable adjustments. In practice, many do not know where to start.
The health inequality
The LeDeR (Learning from Deaths of People with a Learning Disability and Autistic People) programme, managed by NHS England, has repeatedly highlighted medicines-related concerns in its annual reports. Key findings include:
- People with learning disabilities die on average 20 years younger (for men) and 26 years younger (for women) than the general population
- A significant proportion of deaths involved potentially avoidable medication-related factors, including over-sedation, failure to review long-term medicines, and inadequate monitoring of high-risk drugs
- Psychotropic medicines are prescribed to an estimated 30,000–35,000 adults with learning disabilities in England without a diagnosis of a condition for which the medicine is indicated — a practice the NHS STOMP (Stopping Over-Medication of People with a Learning Disability) programme is working to reduce
These are not abstract statistics. They describe a population that uses pharmacy services frequently but whose needs are often poorly met.
What reasonable adjustments look like in pharmacy
The Equality Act 2010 requires service providers — including pharmacies — to make reasonable adjustments to ensure that people with disabilities are not placed at a substantial disadvantage compared to those without. For people with learning disabilities, this means adapting how pharmacy services are delivered, not just what is dispensed.
Communication adjustments
| Adjustment | How to implement |
|---|---|
| Easy Read labels | Use larger font, simple words, pictures where possible. Some dispensing systems support easy-read label formats |
| Plain language counselling | Avoid jargon. "Take one tablet in the morning with food" is better than "one tablet OD p.c." |
| Allow extra time | People with learning disabilities may need longer consultations. Build this into appointment scheduling |
| Include carers appropriately | Ask the patient (not just the carer) whether they want the carer present. Respect capacity and autonomy |
| Use visual aids | Pictorial dosing charts showing when to take each medicine and what it looks like |
| Check understanding | Use teach-back: "Can you tell me how you'll take this medicine?" |
Physical environment adjustments
- Clear signage: use pictograms alongside text
- Quiet consultation space: some patients with learning disabilities find busy, noisy environments distressing. Offer the consultation room proactively
- Step-free access: many patients with learning disabilities also have physical disabilities. Ensure the consultation room and counter are accessible
- Appointment-based access: some patients may find it easier to visit at a quieter time. Consider offering appointments rather than requiring walk-in availability
Medication review adjustments
The Structured Medication Review (SMR) is a particularly important touchpoint for patients with learning disabilities. Pharmacists conducting SMRs for this population should:
- Check for STOMP-relevant prescribing: is the patient on a psychotropic medicine (antipsychotic, antidepressant, benzodiazepine, mood stabiliser) without a clear documented indication? If so, flag to the prescriber for review
- Assess adherence practically: can the patient open their medicine bottles? Can they read the labels? Do they understand the dosing schedule? Practical barriers are common and often unrecognised
- Consider the full regimen: patients with learning disabilities are more likely to be on complex regimens with multiple prescribers (GP, psychiatrist, specialist). Reconciling these is essential
- Involve the patient in decisions: the Mental Capacity Act 2005 requires that every effort is made to support the patient to make their own decisions before concluding that they lack capacity. This applies to decisions about medicines
The STOMP programme
The NHS STOMP programme (Stopping Over-Medication of People with a Learning Disability, Autism, or Both) aims to reduce the inappropriate use of psychotropic medicines in this population. Community pharmacists can support STOMP by:
- Identifying patients with learning disabilities who are prescribed psychotropic medicines without a documented mental health diagnosis
- Raising these cases with the prescriber during SMRs or through the practice pharmacist
- Supporting patients and carers through any reduction process — tapering psychotropic medicines requires careful monitoring and patient/carer engagement
STOMP does not mean that all psychotropic prescribing for people with learning disabilities is inappropriate. Many patients have genuine mental health conditions that require pharmacological treatment. The programme targets the subset of prescribing that is not clinically justified — medicines used to manage behaviour rather than treat a diagnosed condition.
Training and resources
Several free resources support pharmacists working with patients with learning disabilities:
- NHS England Learning Disability and Autism Programme: provides training resources and best practice guidance
- Mencap: offers pharmacy-specific guidance on reasonable adjustments
- GPhC: includes learning disability awareness in its CPD framework — pharmacists can use encounters with this population as CPD entries
- CPPE (Centre for Pharmacy Postgraduate Education): offers learning programmes on health inequalities including learning disability pharmacy practice
Where to explore further
Pharmacists interested in learning disability specialist roles can explore PharmSee's job listings for NHS trust pharmacist positions with a mental health or learning disability focus. The pharmacy search tool provides data on local pharmacy provision, and salary data offers benchmarks for specialist clinical pharmacist roles across the NHS.
Caveats
The 1.5 million learning disability prevalence figure is a Mencap estimate and includes people who may not have a formal diagnosis. The 5.5 medicines average is from NHS Digital analysis and covers registered adults with a learning disability in primary care. The STOMP psychotropic prescribing figures are estimates and are subject to ongoing revision as data quality improves. Reasonable adjustment requirements are summarised here for general guidance; pharmacists should consult the Equality and Human Rights Commission for definitive interpretation of the Equality Act 2010.
Sources
- NHS England: LeDeR Annual Report (2024)
- NHS England: STOMP Programme
- Mencap: Health Inequality and People with a Learning Disability
- Equality Act 2010, Section 20: Duty to Make Adjustments
- NHS Digital: Health and Care of People with Learning Disabilities (2023)
- PharmSee vacancy database, 1,715 active roles as at 15 April 2026