With almost 300 NSW GPs now able to diagnose, treat, and prescribe medication for ADHD, the Royal Australian and New Zealand College of Psychiatrists (RANZCP) says significant investment is still needed.
GP diagnosis and treatment of ADHD will ease pressure on the psychiatry workforce, but it requires safe, high-quality outcomes, the The Royal Australian and New Zealand College of Psychiatrists says, following the NSW government’s announcement yesterday.
RANZCP child and adolescent forensic psychiatry chair Associate Professor John Kasinathan said training more GPs in ADHD assessment and treatment could improve access to timely care, “where otherwise they may face protracted waits and out-of-pocket costs to see a specialist”.
According to the government, ADHD assessments typically cost between $500 and $1500, with large gap fees. Waitlists have been known to stretch to 12 to 18 months.
Moreover, broader inequities in specialist psychiatric care were reflected in the continued under-diagnosis of women and girls, culturally and linguistically diverse groups, and First Nations communities, Professor Kasinathan said.
However, the college called for additional safeguards.
ADHD frequently presented with comorbidities that required navigating challenging, chronic symptoms in patients’ day-to-day lives, he said.
“Symptoms like inattention, impulsivity, and hyperactivity often overlap with various psychiatric conditions – including mood and anxiety disorders, autism spectrum disorders, learning difficulties, psychotic disorder, trauma-related presentations, and substance use disorders,” he said.
While Professor Kasinathan said GPs had become better informed and confident in diagnosing ADHD with the assistance of psychiatrist-led training, he affirmed the importance of maintaining an accurate diagnosis.
“Ideally, we’d like additional safeguards in place, like mandatory comprehensive psychiatric assessment training for GPs, shared care models with specialists, and very clear referral and escalation pathways to psychiatrists,” he said.
“A sensitive and thorough psychiatric assessment must be the foundation of every ADHD diagnosis, which then enables the safe and optimal use of medication for ADHD, which may include either non-stimulant and/or stimulant medications.”
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While the RANZCP chair “welcomed the announcement”, he said significant investment in the public mental healthcare system and further reforms were still necessary to ensure the ADHD and psychiatry workforce capacity was “built in, not bolted on”.
“This is especially important in rural, regional, and remote areas, where support for neurodevelopmental conditions remains scarce and highly fragmented,” Professor Kasinathan said.
Rural Doctors Association of NSW president Dr Rachel Christmas expressed similar concerns, telling The Medical Republic that the initiative offered an opportunity to find better ways to embed ADHD upskilling, as rural and remote GPs were often already booked out months ahead.
Next month, a further 300 GPs are expected to begin endorsed prescriber training, and GP endorsed prescribers will be searchable on the Healthdirect website.
In a separate $1.5 million program, the NSW government announced it would fund up to 25,000 bulk-billed ADHD assessments, paying endorsed prescriber GPs up to $600 per patient for costs including administration and pre-assessment tools.
However, the program is not due to commence until early 2027.
Last week, the PBAC backed broadening subsidised access to non-stimulant ADHD medicines, atomoxetine and guanfacine.
