RACGP demands ADHD reform

From long wait times to high costs and a lack of available practitioners, receiving healthcare for attention deficit hyperactivity disorder (ADHD) in Australia comes with numerous challenges.
 
But the RACGP is advocating for changes that could soon see many of these barriers removed.
 
In a new position statement, the college has called on governments to allow GPs to diagnose and manage the disorder on an ongoing basis, saying that doing so is within GPs’ scope of practice.
 
With there now being widespread recognition of the barriers to care, RACGP President Dr Michael Wright says it doesn’t make sense that GPs are not able to step up.
 
‘ADHD affects over a million Australians and we’re all pretty familiar with the challenges that our patients are having in trying to get diagnosis and treatment,’ he told newsGP.
 
‘It’s expensive, there’s really long delays and it just doesn’t make sense that GPs shouldn’t be able to diagnose, treat and prescribe these medications.’
 
To ensure GPs have got the tools to effectively diagnose and manage ADHD, the RACGP is also calling for additional funding to support ongoing professional development, training and mentorship, as well as an increase to Medicare rebates for longer consultations and increased flexibility for case conferencing.
 
‘We know that ADHD isn’t simple to diagnose and treat,’ Dr Wright said.
 
‘It takes time, and we know the current Medicare schedule doesn’t support GPs to spend that time.’
 
A number of states have taken steps towards allowing GPs to provide ongoing prescriptions for treatments initiated by non-GP specialists, as well as enabling GPs to diagnose ADHD and initiate treatment. This includes New South Wales, Western Australia, South Australia and Tasmania.
 
But Dr Wright says the college wants to see consistent regulations across the country, especially as early diagnosis of ADHD is essential for improved health outcomes.
 
‘The college is calling on federal, state and territory governments to come together to create consistent, sensible regulations to allow GPs to diagnose, prescribe and continue treatment for people with ADHD, no matter where they live,’ he said.
 
Around one in 20 people in Australia live with ADHD, including more than 281,000 children and adolescents and more than 533,000 adults.
 
A report commissioned by the Australian ADHD Professionals Association estimates the disorder costs Australia $20.4 billion each year.
 
Queensland has been a leader in ADHD reform, with GPs permitted to diagnose the disorder in children aged 4–18 since 2017. 
 
Dr Katie Williamson is among those who took up the opportunity. The Cairns GP works out of her neurodiversity focused clinic and says it has been ‘really rewarding’.  
 
‘For more straightforward cases, I’m able to provide care from before the initial assessment to when patients transition to adult care,’ she said.
 
‘For more complex patients, it’s allowed me to refer to paediatrics and psychiatry in a more timely fashion without clogging up the books.
 
‘I’m also able to see patients more regularly for follow-up, particularly in the early stages of prescribing where I like to see my patients at least every fortnight and have them in contact with me by email.’
 
Among Dr Williamson’s patients are the three children of fellow GP Dr Caroline Yates.
 
A fly-in rural GP in Broken Hill, she experienced the barriers to care firsthand, recalling that there were very few paediatricians where the family were based and significant waitlists for ADHD assessments. 
 
‘I heard there was a GP who had a special interest in neurodiversity and ADHD, so we booked in to see Katie,’ Dr Yates recalls.
 
‘Dr Katie now provides ongoing ADHD care for all three of my children. That’s included medication reviews, and preparing care plans to access allied health like a clinical psychologist or occupational therapy.
 
‘We are able to have longer discussions about what’s going on at school and in their social lives. Shorter review appointments allow for monitoring of their sleep, appetite, weight, and blood pressure, etcetera.’
 
Dr Yates says getting this care from a GP made follow-up care ‘so much easier’, as seeing a paediatrician generally meant a 3–6 month wait between reviews. 
 
‘Dr Katie has been so much more accessible,’ she said. 
 
‘She looks after our whole family so understands all our past history and family dynamics, and if she’s on leave, we can see one of the other GPs at the practice who has access to the kids’ notes and history. 
 
‘The accessibility and whole-of-person care Dr Katie provides has made managing ADHD as straightforward as going to our GP, as we would for any other chronic medical conditions. She can now manage them as they all transition to high school and beyond.’
 
While GPs’ role in ADHD in Queensland is focused on paediatrics, Dr Wright says the state’s experience is a prime example of how other parts of the country could follow suit.
 
‘The system has been safe and is really helping kids be diagnosed and get access to treatment in a much more timely and cost-effective way through their GP,’ he said.
 
While the RACGP is advocating for GPs to have greater opportunity to practice within the ADHD space, a recent newsGP poll found 55% of the 1692 respondents are not interested in prescribing ADHD medication.
 
But Dr Wright clarified that the college’s advocacy is not about imposing responsibility on GPs, but rather a chance for more flexibility for both GPs and their patients.
 
‘What we’re trying to do is recognise that diagnosing and treating ADHD is well within a GP’s scope of practice,’ he said.
 
‘Not everyone’s going to want to do this, and that’s fine. Some of us may not want to take up this opportunity, but what we’re really trying to do is give GPs and our patients the opportunities to provide safe and appropriate care to our patients all around the country.’

The release of the RACGP’s position statement comes ahead of the next Health Minister’s Meeting, which is expected to work towards a harmonised approach between states for ADHD prescribing, as well as access to affordable diagnosis and care. 
 
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ADHD position statement scope of practice