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Why did you do this work? The NHS Long Term Plan in England (2019) highlighted Learning Disability (LD) as a priority, setting a 75% target for people with LD 14 years and older to receive an Annual Health Check with their GP. 1 Without accurate systems of measurement and recording of LD for the denominator, a focus on the recorded caseload may create unintended unmet need.We describe the current situation for young people aged 14–17 years with LD in the inner-city, diverse London Borough of Newham, mapping the process from LD diagnosis to attending the LD Annual Health Check. We highlight areas of good practice as well as barriers to healthcare provision, and suggest opportunities for improvement work to promote health and reduce inequalities in young people with LD.What did you do? Recorded LD prevalence in Newham and uptake of the Annual Health Check were collected from available data sets: the Community Child Health caseload, Primary Care dashboards and a recent LD Health Needs Assessment Report. 2 Conversations with 6 service users and 18 key stakeholders (primary and secondary health care, and those in roles linked to social care and education) were held between March and July 2024 to map out the current LD process, from diagnosis to attending the LD Annual Health Check in primary care.What did you find? Between April 2023 and April 2024, 138 /172 (80%) young people aged 14–17 on the GP LD register attended an Annual Health Check. However, using a conservative prevalence of LD as 2.5% in children from the literature, 3 4 we would expect 540 children to be recorded on the GP LD register in Newham. Our observed LD identification percentage is only 32% of the total expected cases.Process mapping helped identify essential steps in the young person’s journey. Better diagnosis, recognition and communication of LD in health services, clearly stating LD as a diagnosis in communication with GPs, and flexible working in primary care to support attendance are all crucial steps in promoting Annual Health Check uptake. There was variation in perceived effectiveness of LD health checks, with continuity of care recognised by clinicians and carers as a helpful factor in optimising healthcare.What does it mean? Using data and experience from an exemplar inner-city borough, we found high rates of LD annual review for recorded LD cases, but evidence of significant unmet need. Process mapping revealed potential solutions, particularly around recognition and communication of the LD diagnosis. Next steps include local service interventions to improve case ascertainment, consolidation of existing data-sets through multi-agency working, and a review of the quality of LD Annual Health Checks.References The NHS long term plan. 2019. https://www.longtermplan.nhs.uk/ (accessed 26/09/24)Public Health Action Support Team (PHAST). Learning Disabilities in Tower Hamlets, Newham and City and Hackney Report, April 2024, https://www.elft.nhs.uk/sites/default/files/2024-05/Learning%20disabilities%20needs%20assessment%20City%20and%20Hackney%2C%20Tower%20Hamlets%20and%20Newham.pdf (accessed 26/09/24)Public Health England. Learning Disabilities Observatory People with learning disabilities in England 2015: Main report, November 2016. https://assets.publishing.service.gov.uk/media/5a81e329ed915d74e3400976/PWLDIE_2015_main_report_NB090517.pdf (accessed 26/09/24)Horridge KA, Bretnall G, Fraser LK. Hospital admissions of school-age children with an intellectual disability: A population-based survey. Dev Med Child Neurol. 2023 Nov;65(11):1511–1519.