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RACGP calls for fast-tracked ADHD reform


Chelsea Heaney


16/01/2025 3:48:35 PM

Ahead of a mass walk-out of NSW psychiatrists, the RACGP says it is now more important than ever for GPs to be granted ADHD prescribing powers.

A psychiatrist sitting down next to a patient.
The Federal Government previously noted that current policy may place ‘unnecessary restrictions’ on GPs prescribing for ADHD in its Senate inquiry response.

It is more urgent than ever before for GPs to be allowed to initiate and prescribe attention deficit hyperactivity disorder (ADHD) medications, with a psychiatrist shortfall on the horizon.
 
That is according to the RACGP, which is demanding the reform be prioritised amid the mass walk-out of 200 New South Wales Health psychiatrists.
 
With these potential resignations to take place next week, leading to a halving of the number of state public hospital psychiatrists, the college is warning this will lead to unprecedented pressure on GPs.
 
In response, the RACGP has called on the State Government to prioritise changes in widening the scope of practice for GPs to treat people with ADHD.
 
RACGP NSW&ACT Chair Dr Rebekah Hoffman called for the State Government to work with the Federal Government to fast-track reforms that could allow GPs to prescribe ADHD medications.
 
‘GPs can help improve access and reduce costs for these patients, and in doing so ease pressure on our stretched health system,’ she said.
 
‘GPs should be able to initiate and prescribe medications for people living with ADHD and manage their care.
 
‘The New South Wales workforce crisis makes these changes even more urgent.’
 
Dr Hoffman said the current system, where GPs can only get approval to prescribe stimulant medications under specific conditions, is worsening the significant barriers people in the state already face in accessing ADHD care.
 
GPs can only apply for this if they are working in rural or remote communities, or if they are practising predominantly in paediatrics.
 
‘We have solutions. Allowing GPs to give more support to people living with ADHD will not only help these patients, it will help ease pressure on our psychiatrist colleagues,’ Dr Hoffman said.
 
The RACGP has long been calling for a nationally consistent approach for ADHD prescribing that helps adults and children with ADHD access appropriate and early support from their GP.
 
The barrier has been a consistent pain point for GPs, with doctors telling newsGP the restrictions are ‘an absolute nightmare’.
 
In December, the Federal Government backed calls for the development of uniform and nationally consistent ADHD prescribing rules.
 
‘The Australian Government supports this recommendation and is aware of the national
inconsistency in prescribing arrangements for some ADHD medications between jurisdictions,
and the complexity this creates for those with ADHD,’ it said.
 
‘The Government is committed to pursuing greater consistency across all jurisdictions and will commit to raising this issue through a Health Ministers’ Meeting for its consideration.’
 
But in the meantime, Dr Hoffman said patients often ‘wait months and pay hundreds of dollars for psychiatrists to confirm their diagnosis and get scripts that could be easily and safely prescribed by their GP’.
 
‘Now the situation is even worse,’ she said.
 
The mass resignation comes after ongoing pay disputes were unable to be resolved.
 
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ADHD attention deficit hyperactivity disorder mental health New South Wales psychiatry


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Dr GP   17/01/2025 8:42:17 AM

Are we not confusing psychiatrists for paediatricians in the majority of cases?

For paediatric presentation, it is nice to have collaborative specialist oversight for a diagnosis which can be quite difficult


Dr Paul Michael Coughlan   17/01/2025 9:51:04 AM

Agreed , prescribing is the end of a complex assessment and diagnostic process which requires access to AH team care ,-OTs and Ed Psychologists.
Without the access to team care , pressure to initiate or prescribe should be approached with caution.
This need thoughtful system reform , including MBS item numbers rather going straight ""to hit prescribe "


Dr Paul Po-Wah Hui   17/01/2025 10:22:58 AM

One day, patients will be able to access psycho-stimulant for a presumed diagnosis of ADHD, after completing a questionnaire and an AI driven Telehealth consultation. Is that what removing the barrier mean? No wonder, majority of medical graduates have chosen non-GP specialties. It’s a no brainer.


Dr Cate Sheppard   18/01/2025 11:32:40 AM

Too true Paul Po-Wah Hui. The apparent epidemic of ADHD needs further thoughtful assessment itself. I feel it has got the point where the diagnosis is losing meaning, and the life long implications for those severely impacted are being lost. Rather than jumping onto the bandwagon , I think RACGP should be pushing for a broader medical and societal exploration of the ADHD phenomenon. I certainly wont be doing assessments as I don't have the skill set for thorough paediatric or adult assessments.


Dr Nilanjana Haque   20/01/2025 7:23:41 PM

call me a cynic but its either ADHD or menopause
what happened to all other illnesses?
is this Big Pharma or is it just us ?


Dr T Tully   29/01/2025 1:06:49 AM

1. Almost all of the symptoms of ADHD are present reasonably frequently in the general population.
2. Not all patients with ADHD need medication. This would suggest ADHD is a yes or no diagnosis and there is no spectrum of the disorder from mild to severe.
3. Where are these GPs who are opening there doors to ADHD diagnostic pathways? Studies have shown we lack the knowledge and confidence to diagnose the condition, we lack knowledge and confidence to manage the condition and we are reluctant to manage stimulant medication prescribing.(1) So who has the time for ADHD diagnostic pathways in primary care? I suspect will not be the GPs speaking for us who have closed their books to see new patients and strictly privately bill only. Cost saving measures for patients could begin here.
4. This messaging devalues our psychiatry colleagues. Can we equally manage prescriptions in chemotherapy for cancer? immunomodulators? GPs frequently complain of being undervalued. Yet.


Dr Timothy Conor Tully   29/01/2025 1:12:15 AM

5. Australia has an over diagnosed and over treated population.(2) It is unlikely we have the resources to educate our GPs and set up pathways to deliver specialised psychiatry care in the community. Over-diagnosis of this condition or over treatment can have harmful consequences for patients.(3)
6. It is likely that there are concerns that if we open up ADHD diagnosis and management to GPs then there will be wider impacts on society and health economics. 1. Wright N, Moldavsky M, Schneider J, Chakrabarti I, Coates J, Daley D, Kochhar P, Mills J, Sorour W, Sayal K. Practitioner review: pathways to care for ADHD–a systematic review of barriers and facilitators. Journal of Child Psychology and Psychiatry. 2015 Jun;56(6):598-617.
2. Glasziou PP, Jones MA, Pathirana T, Barratt AL, Bell KJ. Estimating the magnitude of cancer overdiagnosis in Australia. Medical Journal of Australia. 2020 Mar;212(4):163-8.
1. Kazda L, Bell K, Thomas R, McGeechan K, Sims R, Barratt A. Overdiagnosis of attention-deficit/hyperactivity disorder in children and adolescents: a systematic scoping review. JAMA network open. 2021 Apr 1;4(4):e215335-.


Dr Timothy Conor Tully   29/01/2025 1:12:37 AM

1. Wright N, Moldavsky M, Schneider J, Chakrabarti I, Coates J, Daley D, Kochhar P, Mills J, Sorour W, Sayal K. Practitioner review: pathways to care for ADHD–a systematic review of barriers and facilitators. Journal of Child Psychology and Psychiatry. 2015 Jun;56(6):598-617.
2. Glasziou PP, Jones MA, Pathirana T, Barratt AL, Bell KJ. Estimating the magnitude of cancer overdiagnosis in Australia. Medical Journal of Australia. 2020 Mar;212(4):163-8.
3. Kazda L, Bell K, Thomas R, McGeechan K, Sims R, Barratt A. Overdiagnosis of attention-deficit/hyperactivity disorder in children and adolescents: a systematic scoping review. JAMA network open. 2021 Apr 1;4(4):e215335-.