The Royal Australian College of GPs (RACGP) has called on the Victorian Government to allow GPs to diagnose and prescribe for ADHD after announcements in Western Australia, the ACT, and New South Wales.
The WA Government committed to improving access for patients by supporting specialist GPs to diagnose and treat ADHD in February following long-term advocacy from the RACGP and Western Australian GPs. The NSW Government also recently announced changes to improve access and affordability through treatment by GPs, and the ACT Government committed to allowing GPs to diagnose ADHD in the 2024 election.
ADHD is within the scope of general practice, with education available for GPs through the current curriculum for RACGP GP training and ADHD modules in the College's gplearning platform.
Specialist GPs are often patients' first point of contact for an ADHD assessment and often manage their patients' ADHD in shared care arrangements with treating psychiatrists and paediatricians.
But in Victoria, GPs are not authorised to diagnose ADHD or start patients on stimulant medication, and must obtain a permit to prescribe stimulant medication for each patient under Victorian regulations. As in other jurisdictions, GPs must also receive authorisation for each prescription under Pharmaceutical Benefits Scheme rules.
RACGP Victoria Chair Dr Anita Muñoz said it was time for the Victorian Government to allow specialist GPs with expertise in ADHD to work to their full scope.
"Up to 163,000 Victorian children and 320,000 adults may be living with ADHD in Victoria," she said.
"But many of these patients can't access an assessment, which may currently only be provided by a psychiatrist or for younger patients, a paediatrician. They face long wait times and high out-of-pocket costs, with a comprehensive ADHD assessment in Victoria costing up to $2,000.
"We see this in health equity data, with patients in more rural and lower socioeconomic status areas missing out on care at significantly higher rates.
"As specialist GPs, we care for our patients throughout their lives and are the most accessed and most accessible part of the medical system.
"Enabling GPs in Victoria to diagnose, initiate and manage psychostimulants for ADHD will reduce specialist bottlenecks, improve timely access to treatment and reduce costs for patients, while easing pressure on public hospital outpatient waiting lists."
Dr Muñoz and other GPs from around Victoria will descend on Parliament House on Wednesday 18 June to advocate for reforms including for GPs to be enabled to provide ADHD diagnosis and assessment. She said Victorian GPs are ready.
"This change is past due," Dr Muñoz said.
"Early intervention for children with ADHD is vital. It sets them up to thrive at school and at home. For adult patients, a diagnosis and access to treatment can be lifechanging.
"GPs are well-supported by appropriate prescribing guidelines, and have been successfully managing children with ADHD in Queensland for eight years without issues.
"GPs already manage these patients. The vast majority of Victorian psychiatrists operate in a model where after diagnosis, they pass the responsibility for prescribing among possible options to a patient's GP, who works with the patient to monitor safety, efficacy and side effects.
"But in these shared care arrangements, the GP's role is inconsistent and constrained by red tape that doesn't apply to other specialists, while New South Wales and Western Australia are implementing reforms to improve access to care.
"The RACGP has been working around the country to support access to ADHD care, and we're also calling for nationally uniform rules that will make this simpler.
"The Federal Government committed to this last year, and the RACGP will support its implementation to help GPs break barriers to care for patients across states and territories."
Inequitable access to diagnosis and care was a key issue highlighted by the Senate inquiry into assessment and support services for people with ADHD.
Dr Muñoz reiterated RACGP calls to break barriers to care for patients, including by boosting their Medicare funding for long consultations which benefit patients with chronic conditions like ADHD.
"It is essential for patients to spend the time they need with a GP who's managing their care," she said.
"Boosting funding for long consults by 40% will make the care our patients need far more affordable and accessible, and support bulk billing. There's no substitute for the care you can get from a GP who knows your health and your history."
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