The government's NHS reforms risk exacerbating flaws in learning disabilities services, academics and managers have warned.
The shift to primary care group commissioning could present particular problems, junior health minister John Hutton was warned at a King's Fund seminar last week.
As if to acknowledge the problem, Mr Hutton announced that the Department of Health was setting up a subgroup of its learning disability advisory group to look at the impact of The New NHS white paper.
He promised that future work on learning disabilities would also be informed by a 'seminal' report on the costs and outcomes of different types of residential provision, due to be published later this month.
Mr Hutton admitted that a government survey of 21 local authorities and health authorities had found 'striking' variation in the level of day and residential services for people with learning disabilities, as well as problems in 'reshaping' primary care, specialist and continuing care services.
Managers said GPs were reluctant to take on commissioning learning disabilities services, and in some cases were openly 'hostile' to the idea.
Rob Greig, director of the community care development centre at King's College London, blamed a lack of direction from the centre. 'The general picture is one of organisational disinterest,' he said.
He called for a requirement on PCGs to appoint a lead officer for learning disabilities.
He said a performance management framework should be built from Signposts for Success, the NHS Executive guidance on commissioning and providing learning disabilities services, published last year.
Mr Greig also called for health improvement programmes - 'a potential way forward' - to be closely monitored.
Peter Charlton, director of the learning disabilities directorate at Cornwall Healthcare trust, said: 'Signposts for Success is an excellent document - but do people take notice of it?
'We do need some form of prescription - and we also have to have some standards that can be used in contracting.'
Terry Clarke, clinical director of learning disabilities at Ravens-bourne trust in Kent, said PCGs' 'huge agenda' made it difficult for them to focus on learning disabilities. He said his team had resorted to sending out information to GPs on laminated sheets to improve its chances of being read, after discovering that reception staff tended to put learning disabilities material straight in the bin.
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