GP lobbies Health Minister as paediatrics access reaches ‘tipping point’

Morgan Liotta

17/08/2022 4:24:39 PM

The issue has been called a nationwide crisis and GPs are calling for more support to help improve outcomes for families.

Empty paediatric consultation room.
Many paediatricians across Australia have extended wait times or closed books.

‘We are experiencing a very difficult period of time with many families unable to access a paediatrician for support to manage and diagnose developmental disorders.’
That is Perth GP Dr Andrew Leech, who has a special interest in paediatrics, expressing concern to newsGP.
The situation has deteriorated to such a point that Dr Leech this week wrote to new Western Australia (WA) Health Minister Amber-Jade Sanderson, informing her that GPs are ‘reaching a tipping point, a crisis, associated with the extended wait times and closure of books of paediatricians, in particular developmental paediatricians’.
But WA is not the only jurisdiction to be plagued with paediatrician access issues, as an unprecedented rise of mental health issues among children and young people has left more families across Australia seeking support, with many being turned away.
Sydney-based GP and Chair of RACGP Specific Interests Child and Young Person’s Health Dr James Best told newsGP the issue is of national concern.
‘The lack of access to both diagnosis and even prescribing of stimulants – which GPs are generally not able to do, even repeat scripts – to children who already have a diagnosis of ADHD is at a crisis point,’ he said.
‘Paediatricians and psychiatrists just simply cannot cope with the numbers.’
One WA psychiatrist who sees teenagers from 15 years into adulthood told newsGP that although he doesn’t work in paediatrics, the waiting list for his clientele is ‘very long also’ and it is ‘very hard’ to get in to see a psychiatrist.
Dr Best has heard similar messages from several jurisdictions, not just New South Wales.
‘I have had many conversations with paediatricians, researchers at universities in this area and many paediatric-focused GPs who are all saying the same thing: something needs to be done,’ he said.
Dr Leech’s letter highlights ‘countless stories’ of families who are ‘desperate’ to get the help they need for their child.
‘For the first time yesterday, I had no success with any paediatrician accepting a patient into their care for assessment and diagnosis of a neurodevelopmental disorder,’ he wrote.
‘This is after a series of 10 separate referrals and phone calls. This is with my plea, as a health professional and with my background knowledge that the child needed help.
‘I have had stories of parents lining up at 5.00 am, outside an office of a paediatrician, on hearing they would be offering more appointments.
‘I’ve had parents crying in my office because they no longer know where to turn after 30, yes 30 phone calls, including interstate.’
According to the WA Government Child and Adolescent Health Service, referrals to the state’s Child Development Service (CDS) – which provides free, government-funded assessment, early intervention and therapy services for children – were up 41% in 2021 compared to 2016.
‘Referrals to CDS have been trending upwards over the long-term, particularly over the past five years, leading to increased wait times for services,’ the spokesperson told newsGP.
‘CDS has a strong culture of service improvement and is actively working with the system manager to address the growing demand.
‘Last year, the Child and Adolescent Health Service internally funded additional temporary CDS paediatrician positions as well as paediatric training positions.’
However, with families needing help now, Dr Leech is proposing a number of solutions ‘as a matter of urgency’ so that GPs can be better supported through their coordinated care role with paediatricians.
Outlined in his letter, these include early intervention and training models, and reform to current prescribing processes.
‘The earlier these families have support through a thorough assessment and treatment plan, the higher the chance they will avoid … negative consequences [and] the better off this entire family will be,’ he writes.
‘Not only this, the better off the whole health and education system will be.’
Highlighting the requirement for a patient to see a specialist paediatrician before being prescribed a stimulant as the ‘most significant’ cause of delays in treatment for paediatric development disorders, Dr Leech said this model is ‘failing’ GPs and the families they provide care for.
‘I propose that a legal means is sought as soon as possible to permit [with verbal authority of a paediatrician] the prescribing of certain stimulants by specially-authorised GPs,’ he wrote.
‘To safeguard that process, I also propose the formation of a WA Paediatric General Practice Council that includes at least one paediatrician and/or paediatric psychiatrist.
‘Such a Council would be responsible for the development of training for GPs to better diagnose and manage paediatric developmental disorders in primary care.
‘The training would be accredited annually and reviewed by paediatricians, but need not be too cumbersome because it is most likely this group of GPs already has the skills and knowledge to at least recognise most of these problems already.’ 
Dr Best has long called for GPs’ important role in early intervention and management, including referral pathways, to be recognised and supported through integrated care models.
The implementation of Australia’s first National Children’s Mental Health and Wellbeing Strategy, launched late last year, is helping to lay this framework, according to Dr Best, who was involved in its development.
‘The [strategy] report has got it right and taken note of the critical role of primary care, particularly general practice, in this area,’ Dr Best previously told newsGP.
‘The emphasis on looking at the child in a family or a community context is very sound, and it’s also consumed with the principles of general practice.’
Dr Leech concludes his letter to the WA Health Minister with an appeal for change to set children and their families on the right path to a good future.
‘I am doing this because I strongly believe that we can make a difference in so many situations [and] with so many young lives,’ he wrote.
‘With the right steps and process, I believe this will set the standards for paediatric care in the future.’
The Neurodevelopmental and Behavioural Paediatric Society of Australasia declined to comment and the Paediatrics and Child Health Division of The Royal Australasian College of Physicians were unable to provide comment prior to publication.
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Dr Daniel Thomas Byrne   18/08/2022 7:16:21 AM

This is similar to the example of Epipens for anaphylaxis. They were not on the PBS in the 1990s. The rise and rise of severe paediatric allergies forced the government to put them on the PBS out of fairness and equity of access.
Keep up the pressure Andrew.

Dr Henry Arthur Berenson   18/08/2022 5:12:05 PM

This is not new. It's not just paediatrics, it is adult ADHD and ASD. Psychiatrists discriminate against atypical patients. They call it triage. These are not true psychiatric disorders and I understand why psychiatrists and paediatricians avoid managing them. It's about time the colleges started lobbying to return management to GP specialists.

Dr Suresh Gareth Khirwadkar   18/08/2022 7:59:23 PM

Do we need to upskill GPs in this area or do we just need more paediatricians, psychiatrists and educational psychologists? We need to get past this idea that GPs are able to just plug the gaps in every service.

Dr Philip Ian Dawson   22/08/2022 7:22:04 PM

EpiPens are not prone to abuse and diagnosing anaphylaxis is not hard. Adrenalin in ampoules has never needed an authority but they are cheaper than adrenalin in epiPens. price is the sole reason for authority. Stimulants on the other hand are schedule 8 and are prone to abuse. I have seen a mother overdose on the Dex amphetamine prescribed for her child, who she stirred up before the paediatrician appointment. I don't want to be responsible for monitoring yet more drugs with abuse potential, particularly when more psychology input is a preferable option. I particularly don't want responsibility for supervising stimulant prescriptions to adults.

Dr Bethany Reynolds   31/08/2022 11:35:08 PM

100% I had a mother call 13 paediatricians (in WA) before she finally found one who said they would look at the referral, and only because that paed had connections with the psychologist at that child's school.
I've seen at least 3 areas that need to be addressed to support these families;
1.we need to improve paediatric training in WA, as too many struggle to complete requirements in a timely way without moving interstate.
2. We need more avenues for GPs to continue prescribing stable patients ongoing stimulants, instead of filling up the paediatricians and psychiatrists books with "CCMx" reviews.
3. the NDIS needs to sort itself out about what it requires to get support. I've seen families thriving with allied health support and ndis funding while "awaiting paediatrician assessment" while others are denied funding until a paediatrician signs off, which can take years.