GPs well placed to help tackle ADHD ‘postcode lottery’: RACGP

GPs should play a greater part in addressing rising ADHD presentations across Australia, an RACGP submission to a Senate Inquiry has said.
 
In a seven-page letter, RACGP President Dr Nicole Higgins calls for an expanded role for GPs to diagnose and manage ADHD patients, including acting as care coordinators.
 
She also describes the current access for many patients as ‘inadequate’, highlighting several barriers to diagnosis such as difficulty in accessing specialists, patient costs, and ‘unclear referral pathways’.
 
According to Dr Higgins, appropriate education, training and funding will improve the current situation, allowing GPs to help more patients access the right care, with general practice often the first point of contact for many.
 
‘This holistic, patient-centred, and relationship-based approach places GPs in an excellent position to aid in the diagnosis and management of patients with ADHD and connect patients and their families with other specialists and support as necessary,’ the submission states.
 
The topic has been a particular focus in recent months, following increased media attention, and many GPs reporting a sharp rise in patients presenting for a referral for diagnosis.
  
In a newsGP poll carried out in March this year, more than nine in 10 respondents noted a rise in the number of presentations for ADHD, with 78% of readers reporting a substantial increase.
 
This year, the Government launched the Assessment and Support Services for People with ADHD Inquiry, run by the Senate’s Community Affairs References Committee, after Federal Senator Jordon Steele-John led a push for it to be held.

In its submission, the college said that national shared care arrangements, including clinical protocols and funding systems, would help GPs to access assistance from other health professionals. They would also support diagnosis and management ‘and mitigate risk of both over and under treatment’, the RACGP President wrote.
 
The college points out inconsistencies between different jurisdictions, highlighting how Queensland GPs can diagnose and prescribe stimulant medication if required for patients aged 4–18, while GPs in WA cannot.
 
‘This inconsistency across the country results in a postcode lottery where patients living in one region may more easily access diagnosis and treatment than patients living in another region,’ the letter states.
 
The college also described the recently published ADHD Clinical Guideline as a ‘comprehensive, evidence-based resource for GPs to guide the diagnosis and management of ADHD’.
 
Associate Professor John Kramer, Chair of RACGP Specific Interests ADHD, ASD and Neurodiversity said he welcomed the opportunity for the college to contribute to the work of the Senate.
 
‘The Inquiry is an important step in highlighting the difficulties faced by ADHD individuals and their families in accessing diagnosis and treatment of all types,’ he told newsGP.
 
‘The failure of public mental health services to recognise ADHD as a significant health issue and allocate adequate resources for its diagnosis and treatment represents health discrimination of the worst kind.’
 
He echoed the words of the RACGP submission, saying the role of general practice could be expanded with the right training.
 
‘Many cases of ADHD are relatively straightforward to diagnose and manage effectively,’ he said.
 
‘The access block can be fixed by devolving care to suitably trained GPs, while allowing psychiatrists and paediatricians to concentrate on the more complex cases.
 
‘That’s what we already do with conditions such as asthma and diabetes.’
 
As previously reported by newsGP, the submission cites concerns that the current lack of access is exacerbating financial pressures on patients, particularly for some adults.
 
A ‘severe lack of face-to-face access to psychiatrists’ had led GPs to refer patients to telepsychiatry, with one reporting a fee of more than $700 for diagnosis.
 
‘There are financial barriers to receiving a diagnosis, with patients often paying significant out-of-pocket costs, and many patients needing to travel long distances, sometimes interstate, to see a specialist with availability,’ the RACGP submission states.
 
‘This cost barrier means that people on low incomes are unable to access care and are disproportionately affected by poor access to care.’
 
The RACGP President believes higher rebates for GP management plans, team care arrangements, mental health treatment plans and multidisciplinary case conferences would support patients by reducing costs and improving access to co-ordinated care.
 
‘People living with ADHD also need lifelong and individualised support,’ Dr Higgins said.
 
‘More than two-thirds of people with ADHD have at least one other condition such as autism spectrum disorder, depression, anxiety, and sleep disorders.
 
‘Chronic conditions shouldn’t be treated in isolation, but as part of a comprehensive care plan which is regularly reviewed and has input from a multidisciplinary team stewarded by their usual GP.
 
‘Ensuring that people are able to access allied health services like psychology, only 56% of which were bulk billed in 2021, will also improve patients’ access to the services they need.’
 
The Senate Inquiry is due to deliver its recommendations by 27 September this year.
 
Full details of the Inquiry into ADHD are available on the Parliamentary website.
 
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ADHD general practice Senate Inquiry