Samad is twenty years old. He has autism and learning disability. New and unknown situations and people make him very anxious. He has recently moved from the family home, which is outside your area, and into a local group home. Your surgery treats the residents of this home, who have a range of disabilities. The Home Manager has informed you that Samad was used to being the centre of the family’s attention, and was always given medical treatment within the family home. Because of this you have undertaken home visits with Samad in the first months, following a pattern suggested by the Home Manager. These visits have gone well. However, they are keen for him to learn new skills and want him to attend appointments in the surgery. This would be easier for you in some respects, but your surgery is a large and busy one and it is important that appointments are planned to minimise distress for Samad and possible disruption for your colleagues and other patients.

Strategies

You and the Home Manager agree a plan as follows:

• An examination room is booked to be free for ½ hour either side of the appointment. It is agreed that Samad can go straight to this room, rather than the waiting room. This is a room that can regularly be made available.
• The Home Manager visits and makes suggestions about aspects of the room that can easily be adapted to help Samad cope with the situation. (She suggests using the desk lamp rather than overhead strip light, tidy materials from surfaces, and removing unnecessary chairs to create more space).
• The Home Manager arranges to meet with the entire staff group and run a ½ hour staff development session on ASD. She brings a photograph of Samad so that they will recognise him when he visits.
• On the day of the appointment, the Home Manager calls reception before setting off, so that Samad and his supporter are expected by reception when they arrive and can go straight to the examination room to wait.

Your plan is designed to make the surgery immediately accessible to Samad, with the aim of reviewing the plan to reduce the need for this level of support in time.