Shared care essential if GPs want more ADHD scope

The RACGP wants GPs more involved in diagnosis and management, but it needs to get serious about working with other health professionals.

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The RACGP wants GPs to play a greater role in the diagnosis and treatment of ADHD in a bid to “improve affordability and access to care”, and at least one expert hopes the college really means it.

In its submission to the Senate’s Assessment and support services for people with ADHD inquiry, the college called for:

• support for an expanded role in the diagnosis and treatment of ADHD for GPs with an interest in this area;
• consistent rules across all states and territories on which clinicians can diagnose and prescribe stimulant medications for patients; and,
• funding to support effective shared models of care and appropriate funding for long consultations.

RACGP president Dr Nicole Higgins said too many patients were missing out on care, and GPs could increase their role in the diagnosis and management of ADHD to improve access.

“Access to ADHD diagnosis is inadequate and unaffordable for too many patients,” she said.

“Costs potentially in the thousands of dollars, even interstate travel, for patients who may have ADHD show that not only is access too hard, but that people are desperate for healthcare in this area.

“The recently published ADHD clinical guidelines have given GPs a comprehensive, evidence-based resource to guide the diagnosis and management of ADHD.

“With appropriate support, GPs can step up to help patients, psychiatrists, and paediatricians to diagnose and manage ADHD.

“This will require appropriate training, funding, regulatory change for prescribing and the development of shared care arrangements between GPs and other health professionals.”

Professor David Coghill, president of the Australian ADHD Professionals Association, which developed the clinical guidelines, said he hoped the RACGP was serious about “shared models of care”.

“I very much support the call from the college for more involvement by GPs, because they can contribute to areas of need,” Professor Coghill told TMR.

“But we know that GPs are already stretched, and so I would hope that [the college is] looking at how GPS can work with other professionals in primary care, and not go it alone.”

Professor Coghill said in his experience, well trained nurses and pharmacists were excellent options for taking part in multidisciplinary care for people with ADHD.

Funding, training and appropriate support were key to widening GPs’ scope when it comes to ADHD, he said.

“There are problems,” he said.

“There are issues about access, there are issues about the availability of trained psychiatrists and paediatricians to conduct assessments. Yes, GPs can play an important part.

“But there will need to be training and support. Most GPs have not received training in assessing and managing ADHD. It’s not something that one does lightly.

“But if that training and support and the finances are there – that’s the other big problem for GPs: that the current MBS payments and way that they’re paid … don’t allow enough time.

“Assessing ADHD, like any other neurodevelopmental or mental health condition, takes time.”

Dr Higgins said GPs can play a more active role, including in diagnosis of ADHD in shared care arrangements, but are hampered by rules on diagnosis and prescription of stimulant medication that vary by jurisdiction.

In Queensland, GPs can diagnose ADHD and initiate stimulant medication prescriptions for four- to 18-year-olds; in NSW, GPs can diagnose and initiate prescription for six- to 18-year-olds with permission from the state Ministry of Health.

Trials and pilots where GPs work with paediatricians and psychiatrists to upskill in ADHD treatment – and diagnose and manage patients – are under way or proposed in Western Australia, Queensland, NSW and Victoria, but each state operates under different rules.

In its submission, the RACGP calls for the development of consistent rules that reflect scientific evidence and best practice.

“Some GPs have already taken on an increased role in diagnosing and treating ADHD, but more support and regulatory change is needed,” said Dr Higgins.

“At the moment, it’s a postcode lottery.

“Patients would benefit from consistent rules across all states and territories describing the clinicians that are authorised to diagnose and prescribe stimulant medications. This should include GPs.

“Local, state, and Commonwealth governments should coordinate funding for models of care which support shared care models and clear health pathways for patients.

“Higher patient rebates for relevant Medicare-subsidised services would also improve patients’ ability to get support in managing their ADHD by reducing costs and give more people access to coordinated care between health professionals, including GP management plans, team care arrangements, GP mental health treatment plans and multidisciplinary case conferences.”