First phase of GP ADHD reforms revealed

New South Wales GPs will be able to resupply medication to patients with attention deficit hyperactivity disorder (ADHD) from September, under an initial State Government rollout of ‘landmark reforms’.
 
In the first phase of the state’s reform strategy, GPs can now express their interest in undertaking additional training which, once completed, will enable them to manage resupply prescriptions without needing a formal arrangement with a psychiatrist or paediatrician.
 
The initial rollout (tier one) will prioritise children on stable doses of medication to ensure early and consistent access to care, allowing ‘continuation prescribers’ to prescribe psychostimulant medicines following initiation and stabilisation by a paediatrician, psychiatrist or neurologist.
 
By the end of the year, additional training (tier 2) will begin, enabling GPs to diagnose and initiate medication.
 
Here, ​​’endorsed prescribers’ will be supported to accurately diagnose and manage ADHD in children (from age 6) and adults, including initiating, switching and increasing psychostimulant medicines.
 
The cost of training is being picked up by the State Government to allow as many GPs as possible to take part.
 
NSW Health Minister Ryan Park said the reforms will have a positive impact on patients, saving them time and money while accessing the care they need.
 
‘The beginning of this training is a welcome milestone because it means people, especially children, with ADHD are one step closer to having their condition managed by a GP,’ he said.

The reforms will ease pressure on families which currently have to navigate a costly and overloaded specialist system and endure long wait times, which can delay treatment.
 
The RACGP has worked with other speciality groups and the NSW Ministry of Health to progress the strategy, which RACGP NSW&ACT Chair Dr Rebekah Hoffman describes as an empowering and ‘exciting step forward’.
 
‘GPs are experts in long-term, holistic, complex and chronic care. This reform recognises our role and strengthens the continuity of care for people living with ADHD,’ she said.
 
‘The new training program empowers GPs to expand their scope and ensure more equitable access to ADHD treatment across NSW, particularly for children and families in regional and rural areas.
 
‘We would call for a nationwide approach of consistency and look to all states to replicate what NSW has been able to achieve.’ 
 
Dr Hoffman said she is especially keen to see rural and remote GPs take part in the training.
 
In Merimbula, on the south coast of NSW, GP Dr Jess Weber was quick to express her interest in the training and is feeling ‘positive about the changes’.
 
She says GPs are well placed to assess and treat ADHD, ‘because we know these families, we know the family history and we see these patients on a regular basis’.
 
‘There’s a high proportion of the population affected by ADHD, one in 10 kids and one in 20 adults, and we come across it in our clinic most days of the week,’ Dr Weber told newsGP.
 
‘The reforms are going to make it so much easier for these families to access timely, affordable ADHD care, and it’s something that I do feel is within the scope of what GPs are able to diagnose and manage, provided they have an interest in it – because it obviously takes a lot of time and effort to diagnose and then to also monitor patients on treatment.
 
‘Access to appropriate diagnostic pathways and treatment has been a point of contention for a long time, and is very limited, particularly in regional and rural areas.’
 
Depending on the diagnostic route taken, Dr Weber said local patients can wait up to two years to see a specialist, ‘which is really hard to watch as a family member and as a primary care provider’.
 
‘If we’re just looking at getting a neurodevelopmental assessment with a neurodevelopmental psychologist (without potential access to stimulant therapy) we’re looking at a minimum three-month wait. In some situations, it can be six to 12 months, depending on demand,’ she said.
 
‘But if we’re looking to try and start stimulant therapy, for patients to access a paediatrician, the wait list at the moment is approximately 18 months to two years.
 
‘Access to psychiatrists can also be very tricky, particularly for paediatric patients – you’re probably looking at a 12-month wait to see even a telehealth psychiatrist. And it can be longer in some situations.’
 
Delays can negatively impact many areas of the patient’s life, Dr Weber explains.
 
‘People can’t help the symptoms of their condition – it’s not their fault in any way, but it does have such negative repercussions on their sense of self-worth and their ability to meet their academic and social potential if they don’t have access to effective treatment,’ she said.
 
‘It can be really challenging to make this diagnosis then explain to families that they’re then going to be waiting two years to actually be able to access treatment, because throughout this whole time, their child is still struggling, and that’s really hard to watch as a family member and as a primary care provider.’
 
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