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RACGP fronts ADHD inquiry to fix system ‘serving no one’
An overhaul of Tasmania’s ADHD prescribing could be on the way, at a time when, the RACGP says, GPs are hamstrung by red tape and access barriers.
Dr Tim Jones, RACGP children’s health representative, speaking at a Tasmanian Parliamentary Inquiry hearing on Friday.
The RACGP used a Parliamentary Inquiry to advocate for eased restrictions to support GP-led ADHD prescribing, and multidisciplinary models of care for assessment and ongoing support for patients.
The Tasmanian Parliament’s Inquiry into the assessment and treatment of ADHD and support services has been tasked with examining the adequacy of access to an ADHD diagnosis, supports after an assessment, workforce, and current medication regulations in the state.
At a hearing inside Hobart’s Parliament House on Friday, the RACGP called for immediate action, putting forward recommendations to improve the availability and efficiency of ADHD support mechanisms for adults and children across the state.
Dr Tim Jones, Chair of RACGP Specific Interests Child and Young Person’s Health and Tasmania faculty member, fronted the hearing as RACGP representative to share the college’s asks with the committee.
He told newsGP the state’s current approach to ADHD is in dire need of an overhaul.
‘Practical support services for children and adults are almost non-existent, and every day GPs are reporting suffering and stressed patients and families,’ Dr Jones said.
Private paediatric lists in Tasmania are largely closed to new referrals and public waiting times frequently exceed two years, he says, and increasingly, there is no public option.
At the same time, private adult specialist costs are unaffordable for many Tasmanians and are currently being provided largely via interstate telehealth services where ‘continuity of care is limited’.
‘The current system serves no one,’ Dr Jones said.
‘Patients – child and adult – aren’t getting timely, individualised or affordable care. GPs aren’t seeing their patients thrive. Paediatricians and psychiatrists are not reporting satisfaction. Families don’t deserve to wait to receive a comprehensive assessment and recommendations to receive good care.
‘We need to embrace team-based care, bridge the rural divide with shared-care arrangements and look at innovative models to deliver better care – now and into the future.
‘Shared-care arrangements to support GP-led prescribing for stable ADHD is key to enabling equitable access and allowing more efficient and effective use of our services.’
The RACGP’s key recommendations include:
- ensuring multidisciplinary models of care are the standard
- supporting shared-care arrangements to enable equitable access to assessment and care
- enabling GPs to continue prescribing stimulant medication in the short-term for stable patients with ADHD, without cost and access barriers of frequent regular specialist review
- piloting credentialed GP-led diagnostic pathways for ADHD in areas of high clinical need, with assistance from paediatricians and psychiatrists.
Dr Jones said with Tasmania having a ‘significantly higher proportion’ of paediatric ADHD than any other area of Australia, this points to the limitations of current assessment and support pathways for children and the need to increase the educational supports provided to children.
‘We need to explore the deepening inequity of access for patients with ADHD due to absent affordable assessment and support services,’ he said.
‘As GPs we have a strong interest in early intervention to deliver best outcomes, so we [need] options to rollout Tasmanian family access to parent–child interaction therapy as a low-cost, high-value, evidence-based intervention for children displaying early hyperactive and/or inattentive traits.’
The Tasmanian Inquiry comes amid the
RACGP’s ongoing calls for nationally consistent models of GPs sitting central to diagnosing and managing patients with ADHD, including prescribing stimulants, with its
2023 submission into a Senate Inquiry highlighting existing barriers.
This week RACGP Queensland spokesperson
Dr Bruce Willett added to those calls to be answered in his state, and RACGP Tasmania Chair Dr Toby Gardner
asked the incoming government earlier this year ahead of the state election to commit to support this ‘important area’.
Tasmanian GP and children’s health advocate Dr Tim Jones presented the RACGP’s key recommendations for improved ADHD management to Parliament on 18 October.
As national
rates of ADHD diagnosis rise, Tasmania’s challenges of inequitable access and care are in part due to lack of training in diagnoses, according to the RACGP.
But if trained GPs were supported to provide longitudinal care, including prescribing, by extending or removing non-GP specialist review requirements beyond the currently typical 1–3-year interval for stable patients with ADHD, the burden on existing diagnostic services would be eased.
‘The balance of services doing diagnostic work versus regular reviews would shift toward GP longitudinal care,’ its submission says.
‘A model such as this could be facilitated through a bulk-billed GP Management Plan, thereby reducing the cost burden on Tasmanian families who require frequent and regular non-GP specialist review.’
Improving access to ADHD medications remains a priority for the RACGP, as it calls for a review of regulations regarding access to these medications, including the
Tasmanian Poisons Act 1971 and Pharmaceutical Services Branch administration.
Current
Tasmanian legislation supports a single prescriber for stimulant medication model that requires regular non-GP specialist review.
The Act restricts interstate prescriptions of certain medicines, including the psychostimulants commonly used to treat ADHD, which the RACGP labels as ‘restrictive and onerous’, discouraging GPs and psychiatrists from treating ADHD ‘in a timely and equitable manner’.
Tasmanian Health Minister Guy Barnett announced on Friday that changes to the Act could be on the way, revealing plans to change the laws to allow prescriptions issued interstate to be filled in Tasmania.
‘The proposed changes will, with appropriate safeguards, mean that Tasmanians can access medicines that have been legitimately prescribed by an appropriately qualified health professional in the state,’ he said.
‘The proposed changes will, with appropriate safeguards, mean that Tasmanians can access medicines that have been legitimately prescribed by an appropriately qualified health professional in the state.
‘This will ensure we have a contemporary and user-friendly legislation that continues to ensure the right balance between access and controls to high-risk prescription medicines.’
Legislation on these changes is expected to be considered by Parliament early in the new year. In the meantime, Tasmanian GPs can continue to work with interstate specialists to apply for an authority to prescribe those medicines and have them dispensed by Tasmanian community pharmacies.
Dr Jones, who is also RACGP Senior Regional Medical Educator in the state, said the ‘unprecedented challenges’ GPs and patients are facing in access to equitable assessment and support for ADHD presents an opportunity.
‘To re-focus our health services towards community-centric individualised and long-term support through a healthy relationship with a GP,’ he said.
‘We have a large number of motivated GPs here in Tasmania who are keen to further deepen their clinical scope to provide additional assessment and support resources for our patients.
‘We know that if these models can be explored it will lead to a healthier population and lower health costs for all.’
Representatives from ADHD Australia, headspace, the Australasian ADHD Professionals Association, and the Tasmanian Department of Health also attended the hearings on Friday.
The Inquiry Committee is due to hand down its findings and recommendations in March next year.
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ADHD ADHD diagnosis children’s health multidisciplinary care paediatrics RACGP submission Tasmanian Parliament
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