GP sentiment toward managing ADHD in general practice has had a major turnaround in just 18 months, Healthed survey data shows.

In November 2023, more than two-thirds of GPs said that if given the option, they would not choose to diagnose or treat more ADHD patients. But fast forward to this month, and two-thirds said they were at least somewhat likely to take part in additional training so they could diagnose and manage ADHD patients.

With state health ministers working towards a consistent national approach to ADHD prescribing, why is it so many GPs seem to have changed their minds about getting involved?

One possible reason is that ADHD has featured heavily in mainstream media over that period, says clinical psychologist Professor Adam Guastella, Michael Crouch Chair in Child and Youth Mental Health and co-lead of the Child-Neurodevelopment and Mental Health Team at the University of Sydney.

“There’s been a Senate inquiry and there’s been a lot of media about the Senate inquiry and the impact of ADHD on people’s lives,” he says. “There’s been huge engagement from the community in terms of advocating for the needs of people with ADHD. So I think that has probably filtered down.”

Paediatrician Dr Alison Poulton, a senior lecturer at the University of Sydney who has been running a clinical trial training GPs to manage ADHD, agrees the Senate inquiry and media spotlight have probably contributed to the turnaround.

“There’s an awareness of the massive suffering people go through when they can’t afford huge expense to get their ADHD diagnosed and treated. There’s been much more publicity around that side—and GPs are compassionate people,” she says.

When we asked GPs what they saw as possible advantages of expanding their role, many cited benefits for patients, including shorter waiting times and more affordable care.

“GPs are just as good as psychiatrists to make this diagnosis, and will not charge such outrageous fees. They will offer follow-up that patients can afford,” one GP said.

Increased pressure to diagnose and treat?

When it comes to possible disadvantages of their expanding role, the overwhelming concern was potential pressure to diagnose ADHD, which could increase the risk of misdiagnosis and misuse of stimulants.

“It is very difficult to dissuade patients once they have decided they have ADHD: They are more likely to shop around to find someone who will give them the diagnosis/medication than put in the work to figure out what is actually causing their issues,” one GP commented.

However Dr Poulton says the NSW Health reforms take precautions to prevent this. Only GPs who have completed additional training will be able to manage ADHD patients, she explains, and other GPs can refer patients seeking ADHD diagnosis or treatment to colleagues who are better equipped to deal with them.

NDIS unlikely to drive influx

While several GPs in the survey worried they’d be inundated with patients seeking an ADHD diagnosis to access NDIS funding, as some argue has occurred with autism, Professor Guastella says ADHD is likely to be different.

Although autism rates have risen sharply in Australia—with one report suggesting that the NDIS could account for 47% of  the increased reported prevalence since 2012, people with ADHD alone rarely meet the NDIS eligibility criteria, he says.

“In fact, while the NDIS hasn’t come out and explicitly stated it, it’s fairly well established that ADHD by itself has not been, if you like, a diagnosis of choice for NDIS access,” he explains.

“Key to getting any support is showing quite a substantial amount of functional impairment and it’s actually quite hard to do that via ADHD under the current framework.”

Specialist support and adequate remuneration key to success

Professor Guastella stresses that GPs who take part in ADHD diagnosis or treatment will need adequate support from specialists.

“When there are lots of comorbidities it can be really complex both to do the initial diagnosis, but then also to understand how the different medications might interact to provide effective treatment,” he explains. “So I think that that’s where the GPs are really going to need to be supported to provide the best practice care.”

They would also need to be remunerated fairly for the time and effort it takes to manage ADHD patients, he adds.

What your colleagues are saying:

Adequate training essential

“Adequate diagnosis requires PROPER training and is beyond the resources, especially time, of most GPs. However, once assessed, GPs should be able to prescribe medications without having to go through a whole lot of bureaucratic rigmarole.”

GPs managing clearcut cases is a better use of resources

“I do not find it a good use of a limited resource (psychiatry and patients’ finances) to send a clear case of ADHD to a psychiatrist to confirm a diagnosis already made and then to repeat visits in 2 years when medication management has been straightforward.”

Pros and cons

“May be advantageous to reach more people in a cost-effective way who may not otherwise have had access to diagnosis and treatment. Disadvantageous to over-diagnose and risk alienating regular patients who have self-diagnosed and expect treatment.”

“Advantage is that people will have easy access to assessment and treatment. Disadvantage is that GPs are already time short and there could be a surge of people relying on GPs for diagnosis and treatment.”

Overdiagnosis fears

“I think placing this role in the GP domain will result in considerable overdiagnosis, anxiety and overtreatment.”

“It is a time intensive procedure for diagnosis and follow up – this is probably the biggest deterrent to committing to such a high demand area unless you have a special interest in it.”

Concern about becoming a ‘specialist-generalist’

“I am a bit hesitant about additional training as I am worried, I will see only ADHD patients, and I really like seeing diverse patients with a wide variety of problems. Dealing with just ADHD would get boring quickly unless it would be a way of getting better funding for what I already do.”
Political cop-out

“It is a political cop-out for adequately resourcing and paying for specialised services rather than addressing workforce shortages and price gouging by some psychiatrists.”

Scope creep

“Feels like more scope-creep, where specialist assessment and management are dropped on GPs and will eventually be considered routine GP work without sufficient training – where specialists begin to refuse to accept referrals as they consider it now a primary care issue.”

“Due to lack of access to psychiatrists and cost of psychiatry, GPs are being asked to expand their field of expertise.”