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Senate backs general practice to have larger ADHD role


Matt Woodley


7/11/2023 4:52:03 PM

Allowing GPs to play a greater part in diagnosis and management could reduce harms caused by existing treatment barriers, a bipartisan committee found.

GP speaking to child and parent.
GPs have said they are ready to take on more responsibility for ADHD diagnosis and management.

A Senate committee’s seven-month inquiry into ADHD assessment and treatment barriers has produced a host of recommendations, including for GPs to play a greater role in diagnosis and management under a shared care model with other health professionals.
 
The final report, which took into account 701 submissions and testimony from 79 witnesses, including RACGP President Dr Nicole Higgins, highlights long waits for non-GP specialists and high costs as significant barriers for patients living with the condition.
 
Aside from recommending that GPs be supported to work closer to the top of their scope in this space, the Senate Community Affairs References Committee also said the MBS should be reviewed in an effort to improve access to assessment, diagnosis and support services.
 
Similarly, it called for the Federal Government to develop uniform prescribing rules and review PBS diagnosis requirements for access some medications, including age restrictions, dosage restrictions and the scope of practice for prescribing clinicians.
 
Many of the RACGP’s recommendations were included in the final report, and college Vice-President Dr Bruce Willett confirmed GPs are ready to take on a greater role.
 
‘We welcome the review and support movement towards a nationally consistent approach that helps adults and children with ADHD and symptoms of ADHD to access support via their GP and a coordinated team of health professionals,’ he said.
 
‘Many GPs are ready to help individuals and families who need support with ADHD in a shared care model with psychiatrists, paediatricians, and allied health professionals.
 
‘There is also scope for increasing rebates for longer consultations which are currently lower per minute for longer consultations, which disadvantages people who require more time with their GP, including patients with ADHD.
 
‘Increased investment in longer consultations is a simple way to build additional support for these patients.’
 
With ADHD potentially costing Australia more than $20 billion each year, Dr Willett said enabling GPs to improve early diagnosis and better support people living with the condition would have huge economic benefits.
 
‘Funding for shared care models coordinated by GPs is so important … [it] could not just reduce the impact on our patients, but also lead to substantial savings,’ he said.
 
‘A team-based approach with GPs coordinating with psychiatrists, paediatricians, and allied health professionals will help patients get consistent, coordinated care.
 
‘At the moment wait times for a diagnosis can be several months, and a diagnosis can cost a patient more than $700 for a telehealth diagnosis – though we have seen reports of people paying as much as $3000.
 
‘GPs can alleviate that burden, and as this report recognises, the recently published ADHD clinical guidelines have given GPs a comprehensive, evidence-based resource to guide the diagnosis and management of ADHD and the Government should implement this framework into practice.’
 
Perth-based Dr Andrew Leech has a special interest in children’s mental health and the testimony he delivered during one of the hearings was cited in the final report.
 
He told newsGP the RACGP ADHD WA working body has been advocating for greater GP involvement in ADHD management for the past 12 months and said there is an urgent need for the Government to act on the recommendations.
 
‘Psychiatrists are no longer able to keep up with the demand, which is evident by the frequent rejection of referrals,’ Dr Leech said.
 
‘It is critical that the patient’s primary care provider is able to diagnose and manage this condition, which is as common as diabetes yet has far more roadblocks.
 
‘Empowering other health professionals who are given additional training is now a priority.
 
‘There is no reason why GPs should not be able to provide a diagnosis and treatment without specialist input but we do also need greater access to specialists for cases that are more complicated.’
 
He also said it is important to address the stigma attached to ADHD, which he believes stems from the difficulty in accessing diagnosis and treatment.
 
‘ADHD can be a serious medical condition and lead to very poor outcomes,’ Dr Leech said.
 
‘Patients deserve the opportunity to receive an assessment without stigma, without having to jump through hoops and have referrals rejected, and without significant cost.
 
‘It takes a whole system to improve and work together but the Government needs to support us.’
 
Meanwhile, Dr Michaela Baulderstone, a member of RACGP Specific Interests ADHD, ASD and Neurodiversity, described the recommendations as ‘encouraging’ and said she welcomes measures that support the highest standards of care for Australians living with the condition, such as uniform prescribing rules. 
 
‘GPs in Australia have identified disparate state regulations around ADHD medication prescribing as being a significant challenge for patients and their treating professionals,’ she said.
 
‘More importantly, the expertise of Australians living with ADHD was supported with the recommendation that the Australian Government “consult with people with lived experience of ADHD, healthcare colleges and organisations to identify additional supports to improve access to ADHD healthcare and support”.  
 
‘It is heartening to see the Senate recommendations also support steps towards addressing the costs of care and developing shared care models, which acknowledge the critical role of the GP in the life-long care of Australians diagnosed with ADHD.’
 
In the wake of the report dropping, Federal Health and Aged Care Minister Mark Butler said his department will examine the recommendations ‘very closely’.
 
‘This was an inquiry that attracted a lot of interest from members of the community, people who have been diagnosed with ADHD, their families and clinicians as well. So, it is an important landmark inquiry that we take very seriously,’ he told reporters.
 
‘There is more to do, but we are already putting in place new supports for consumers, for families, and importantly for clinicians as well, to support Australians with ADHD.
 
‘The Senate Inquiry will be an important addition to recommendations that government can consider as we provide those better supports in the future.’
 
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Dr Tavia Goodison   8/11/2023 8:40:37 AM

I would love to be part of diagnosis but would like to see a training requirement attached and a requirement that it be face to face (extreme rural exceptions) so we don't see a glut of telehealth providers giving low quality medical care like we've seen with some of these popup telehealth ADHD providers that charge a mint for a diagnosis but offer no care and don't even write to GP afterwards. In Qld with the requirement for a letter of support from a psychiatrist to prescribe stimulants patients have been absolutely ripped off by these services and have ended up out of pocket and on waiting lists anyway.


Dr Sanjeevan Nagulendran   28/11/2023 8:50:32 PM

It’s clear that Ahpra have failed to regulate these drs where commercial interests comes before patient care. Often these companies are run by greedy non medics. This whole culture of making money before looking after patients has made the public lose confidence in the profession. For years until the govt has stepped in with recent Medicare investment into primary care our most vulnerable have been ignored. A national disgrace and an abandonment of why we all came into medicine and the Hippocratic oath - all led and regulated by ahpra. Standardised fees across the board and free health care for the most needy in our society so this rorting can come to an end must be enforced. Medicare has the chance to be the best system in the world if it is organised and fair to the drs and the patients. Means tested standardised fees with better health literacy will improve outcomes by improving access. Let’s simplify Medicare, make it fair and make it the world’s best healthcare system.