WA GPs push for ADHD prescribing rights

With no public pathway to diagnosis and even private psychiatry waitlists ballooning, patients in Western Australia are forced to see out-of-state specialists.

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West Australians seeking an ADHD diagnosis have been left with no option but to see interstate specialists as the state government drags its heels on funding a GP-led pilot.

The state’s only public ADHD clinic exclusively treats children, forcing adults seeking ADHD assessment and diagnosis into the private sector.

Unlike in Queensland and NSW, WA GPs cannot provide a diagnosis or prescription of stimulant medication to any patient, no matter their age.

Wait times to see a private psychiatrist stretch up to a year. The public paediatric clinic wait time has ballooned to almost three years.

Some patients have turned to interstate specialists, either making the trip out east to be assessed face to face or doing telehealth.

Speaking at a 2023 Senate committee hearing in Perth, one clinician relayed the story of a WA patient who flies to France when they require ADHD medicine rather than languish on a WA waiting list.

In partnership with ADHD WA and the state PHN, the RACGP put together a plan for a shared care pilot program to provide children with a fast-track diagnostic pathway.

Under the proposed program, GPs would take a patient’s history, do a full examination including an ECG and administer an ADHD assessment.

This information would then be sent to a paediatrician to provide a formal diagnosis and prescribe stimulants if needed.

GP Dr Andrew Leech ran a small-scale pilot of the program out of his own practice over six months, during which time he saw about 20 children for assessment.

“After one or two longer consults where we’d actually gotten to know what’s going on and the issues [each child was having], I would present their case to the paediatrician and the paediatrician would then … see the child,” Dr Leech told The Medical Republic.

“The time needed for that paed review was a lot less, because we’d already done … a lot of the legwork.”

The real magic of the pilot, Dr Leech said, came in the follow-up.

“The paed would send the patient back to me a couple of weeks later, and I could continue to care for the child and continue the journey with that family … no matter the outcome,” he said.

Expanding the program in size and scope – e.g. creating a pathway for adults seeking a diagnosis – is contingent on funding for GPs to carry out detailed assessments and do additional training in ADHD management.

Dr Leech and colleagues put in a funding proposal to the WA government over six months ago and have not heard back.

In the meantime, state Health Minister Amber-Jade Sanderson has announced a $40 million cash injection for the WA Child Development Service, which will significantly expand access to paediatricians in the state.

“[The current wait time] is impacting the mental health of these children, and the learning outcomes and self-esteem and family dynamics and the behavioural side [are all affected too],” Dr Leech said.

“This is exactly what GPs should be managing … but we’re being disempowered because we’re being told we’re not allowed to diagnose and prescribe for these neurodevelopmental conditions.”

Up until recently, state law only allowed ADHD stimulants to be dispensed in WA if a WA doctor had written the script unless they applied for a special permit.

As reported in The Sydney Morning Herald, the permit process proved such a barrier that patients were getting friends or colleagues to fill their prescription in the state it was prescribed in, then getting the medicine physically mailed to WA.

In December 2023, the state’s Schedule 8 medicines prescribing code was updated to allow stimulant scripts from telehealth doctors to be dispensed at WA pharmacies, putting an end to pills-by-post and bringing WA into line with the rest of mainland Australia.

At least it would have done so, had the change been communicated to pharmacists or doctors.

“I found out from a colleague of mine in February, who said they believed that specialists in other states can prescribe for WA patients,” psychiatrist Dr Roger Paterson told TMR.

“I said ‘no, no, WA is holding out, we haven’t changed’… unfortunately, the communication between clinicians and health departments tends not to be terribly good, despite the efforts of clinicians.

“One starts using phrases like ‘ivory towers’.”