The Royal Australian College of GPs (RACGP) has called for changes that would allow patients across the country greater access to life-changing ADHD care.
The new RACGP position outlines that specialist GPs should be able to practise to their full scope in ADHD to provide patients affordable and accessible high-quality diagnosis and management, helping families and families access care more effectively.
With non-GP specialist cost and wait-times proving a major barrier, especially in disadvantaged areas, RACGP President Dr Michael Wright said GPs are ready and able to ease the strain on patients, families and the wider healthcare system.
"Specialist GPs are Australia's most accessible and most accessed medical professionals, and we're ready to practise to our full scope in ADHD," he said.
"Untreated ADHD costs Australia over $20 billion each year. The reforms we're calling for aren't just what patients on wait lists and their families have been calling for, they're cost-effective and evidence based.
"And as our new position notes, ADHD also has other impacts on individuals and our communities. Patients with untreated and unrecognised ADHD face a potential 13-year reduction in their lifespan.
"Patients in custodial settings have significantly higher rates of ADHD, and crime due to ADHD is estimated to have cost $307 million in 2019. "Up to 10% of children and adults live with ADHD, but early intervention can help them thrive.
"Most, if not all of us know someone who's benefited from care. Allowing GPs to work to our full scope in ADHD, as we have for children in Queensland for almost a decade, will benefit communities and give thousands of kids and adults the opportunity to access life-changing care."
Queensland GPs have been able to diagnose ADHD in children aged 4–18 since 2017.
Cairns GP Dr Katie Williamson provides initial and ongoing ADHD care at her neurodiversity-focused Kaleidoscope Clinic, working with paediatricians and child psychiatrists for complex cases.
"I find it really rewarding," she said.
"For more straightforward cases, I'm able to provide care from before the initial assessment to when patients transition to adult care. 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.
"Not all paediatricians and psychiatrists have been trained in ADHD assessments and management. The limited access to those specialists, especially in rural and lower-socioeconomic areas, has left many patients undiagnosed and untreated as well. Something needs to change."
Three of Dr Williamson's patients in Cairns are the children of Dr Caroline Yates, who works part time as a fly-in rural GP in Broken Hill.
She started managing Caroline's 13-year-old son several years ago, and has since assessed, diagnosed, initiated treatment, and provided ongoing ADHD care for her twin son and daughter, aged 10.
"At that stage we only had a few paediatricians where we are, and there was a huge waitlist for ADHD assessment for those with open books, and at least a 12-month wait at the public hospital," Dr Yates said.
"I heard there was a GP who had a special interest in neurodiversity and ADHD, so we booked in to see Katie. At that stage my eldest had already been diagnosed, but had not been on medication for over a year. He was ready for a review of his treatment.
"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 OT. 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.
"Getting this care from a GP has made follow-up so much easier. To see a paediatrician generally meant waiting 3–6 months between reviews. Katie has been so much more accessible.
"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."
The new RACGP position on GPs' role in diagnosis and management of ADHD recognises:
- ADHD diagnosis and management is within a specialist GP's scope of practice
- GPs are well supported to further develop their knowledge and skills through existing evidence-based guidelines, tools, online training, and other activities and resources
- specialist GPs are well-positioned to support accessible and cost-effective diagnosis and management of ADHD
- early diagnosis of ADHD is essential for improved health outcomes to people with ADHD
- reforms are needed to remove red tape that stops GPs providing this care.
The next Health Minister's Meeting is expected to work towards a harmonised approach between states for ADHD prescribing and other opportunities to access to diagnosis, care, and affordability.
