Call for more GP training to deal with ADHD

Accrediting experienced GPs to treat patients with attention deficit hyperactivity disorder (ADHD) would help deal with a recent surge in presentations, newsGP has been told.
 
This week, the ABC reported on an ‘explosion’ in diagnoses and a corresponding increase in ADHD clinics offering large salaries for psychiatrists and charging very high prices for appointments predominately conducted using telehealth.
 
As previously reported by newsGP, the ABC also highlighted a significant increase in the medications being diagnosed for the condition, and detailed ever-expanding waitlists while describing clinics charging fees of $3000 for patients to expedite diagnosis and treatment. One observer described the situation as ‘blatant price gouging and exploitation’.
 
For Dr Cathy Andronis, Chair of RACGP Specific Interests Psychological Medicine, the report raises significant concerns.
 
‘It’s always disturbing to hear about desperate patients paying extraordinary fees to private providers because the public health system cannot provide essential mental health services,’ she told newsGP.
 
‘Getting a timely assessment and management of significant chronic mental distress should be an absolute in a wealthy first world country like Australia.
 
‘Our mental health system is broken for those who are most disadvantaged or poor. ‘
 
Dr Andronis believes the workforce shortage highlighted in the report is a gap general practice could help cover.
 
‘Trained, accredited GPs with a specific interest in mental health and ADHD are absolutely capable of providing assessment, diagnosis and ongoing management of ADHD,’ she said.    
 
‘Many GPs can and want to do this work and the demand is overwhelming.’  
 
That view was also expressed in the ABC article, with psychiatrist Dr Dianne Grocott, who specialises in ADHD, suggesting that training more GPs would help share the increase in caseload.
 
‘If we can get ADHD back into primary care, into the hands of trained GPs, [this] will be a blip in history,’ Dr Grocott told the ABC, referring to the recent surge in cases.
 
Such a step would also help alleviate the stress many GPs feel when they see patients who suffer needlessly due to lack of services, according to Dr Andronis.
 
‘We wouldn’t dream of denying access to hip replacements or heart pacemakers for our adult patients but we ignore the fact that the suicide rate in Australia is unacceptably high, especially for younger people in the prime of their life, and particularly if they have mental illness that is poorly managed,’ she said.
 
She believes there is a subset of experienced GPs with specific interests in psychological medicine and ADHD who would be ready to undertake the work.
 
It is a view shared by Associate Professor John Kramer, Chair of RACGP Specific Interests ADHD, ASD and Neurodiversity.
 
‘Uncomplicated ADHD is not too hard to manage,’ he told newsGP. ‘It’s a case of just keeping an eye on certain parameters and checking in.
 
‘The diagnosis can be more difficult in some circumstances, but even if GPs aren’t making the diagnosis or providing stimulants where necessary, they can do a shared prescribing arrangement with psychiatrists – paediatricians in the case of children – or take over prescribing completely.’
 
He notes that a Senate inquiry into ADHD is currently underway, with both practitioner workforce training and access to medication among the terms of reference.
 
With submissions still open, Associate Professor Kramer is urging GPs to make themselves heard.
 
‘I would encourage any person with an interest in the area who’s dissatisfied with the current way of things [to] make a submission,’ he said.
 
While the recommendations of that inquiry will not be known at least until September, Dr Andronis believes a way forward could be found by putting in place an accreditation process open to GPs similar to that recently developed for eating disorders.  
 
‘This would require government funding to set up and administer, at least to start with,’ Dr Andronis said.
 
‘If this is successful, it will encourage more interested GPs to train if interested.’
 
Dr Andronis says the main obstacle to GP mental health assessment and management is poor remuneration of longer and more complex presentations.
 
‘More investment into general practice including reinstating the mental health nurses in practices would be an important and significant enabler,’ she said. 
 
‘GPs can definitely do this work efficiently and cost effectively but they need more supports – this is a win-win for all involved, especially the patients.’
 
Associate Professor Kramer believes his experience is a case in point to support more involvement of general practice in ADHD diagnosis and treatment.
 
‘My own situation, I’ve been an approved prescriber for New South Wales Health for over 25 years,’ he said.
 
‘I’m in a rural area and because of the lack of paediatricians, I was granted that and I’ve just kept going.’
 
With more than 700 members of the specific interest group he chairs, Associate Professor Kramer says there is a demonstrable and widespread engagement with the condition among GPs.
 
‘I’ve proved that it can be done from general practice,’ he said. ‘It’s a special skill … so additional training is required.
 
‘But because of the huge access block to specialists, we’ve got to get GPs involved. It’s a public health issue, and there are huge numbers of people who need access to assessment and treatment, and they simply aren’t getting it.’
 
The Senate inquiry into ADHD is open for public submissions open until 9 June. Full details are on the Parliamentary website.
 
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ADHD attention deficit hyperactivity disorder