Canberra pilot program to allow select GPs to diagnose ADHD and prescribe medication
In short:
ACT Health will soon roll out a pilot program allowing select Canberra general practitioners to diagnose ADHD and prescribe appropriate medication.
Canberrans have faced lengthy waits for diagnoses with paediatricians and psychiatrists, often travelling interstate to access care more quickly.
What's next?
The pilot, starting in six months, will see around 20 doctors able to diagnose ADHD, and more than 50 able to prescribe stimulant drugs to young people.
For Deranie Jackson, finding a specialist in Canberra to assess her child for attention deficit hyperactivity disorder (ADHD) was like finding a needle in a haystack.
"We didn't actually manage to get one in Canberra,"Ms Jackson said.
Instead, on a friend's recommendation, Ms Jackson made an appointment for Phoebe with a psychologist in Orange, 300 kilometres from home.
Within weeks, Phoebe had their diagnosis — a moment the Year 12 student, who uses they/them pronouns, described as empowering.
"For me, the main thing it impacted was my school life," they said.
Pheobe Jackson says receiving their ADHD diagnosis was empowering. (ABC News: Ian Cutmore)
"It made me realise that I wasn't really bad at these subjects, I just process slower and need a slower environment.
"That was so amazing to realise that it wasn't that I couldn't do work, I just needed a different environment."
The diagnosis came in late 2023 but by November last year, it became clear that Phoebe could benefit from medication to treat their ADHD.
"Phoebe was really struggling with school, despite working so hard," Ms Jackson said.
"There were days when Phoebe just couldn't think properly, and I just knew they couldn't do their HSC under these conditions."
Psychologists are unable to prescribe medication for ADHD so the hunt for a specialist — namely, a psychiatrist — began.
Canberra mother Deraine Jackson says trying to organise getting Phoebe prescribed ADHD medication has been distressing. (ABC News: Ian Cutmore)
Phoebe's general practitioner (GP), who specialises in ADHD, gave them and Ms Jackson a list of eight specialists in the ACT to contact.
"I have spent eight months making phone calls, trying to get in, sending emails — and they've either not got back or their books are closed or they only do under-18s," Ms Jackson said.
"Even though we've got a diagnosis and we've already paid more than $1,000 for that, it was still such a struggle to find a psychiatrist.
"I was getting so distressed as a parent, it was really heartbreaking."
No one on the list could see Phoebe ahead of the HSC in October, so Ms Jackson called the psychologist in Orange who made the diagnosis and was recommended a psychiatrist in Albury, more than 300km away.
They have an appointment later this month.
Phoebe said it had felt like they were in a race against time to access medication before the HSC started.
Phoebe Jackson says they want to begin ADHD medication before their HSC. (ABC News: Ian Cutmore)
"It's just taken so long and such a toll — I see Mum making phone calls all the time and I'm so grateful that she's doing all that for me," they said.
"I really want the medication in time so I don't do really badly on the HSC because I really dislike not doing my best, which is what can happen if I'm not processing properly."
As for Ms Jackson, the single mother doesn't understand why such a common condition is so hard and expensive to diagnose and treat.
"If I injure my ankle, I call the physiotherapist and I have an appointment the following week,"she said.
"This is life and death stuff for our children and it's not that the professionals aren't amazing, they just don't have capacity. There aren't enough of them.
"I don't know why it's so hard."
Soon, it will not be.
'There is a need now': Chief psychiatrist
ACT chief psychiatrist Dr Anthony Cidoni says they want to ease the pressure on waiting lists for ADHD treatment and diagnosis. (ABC News: Matt Roberts)
The ACT's chief psychiatrist, Dr Anthony Cidoni, made a commitment in May last year to improving access to ADHD diagnosis and prescribing within 12 months.
A little beyond that deadline, he has revealed plans for a pilot program that will see GPs given more authority to diagnose the condition and additional powers to prescribe ADHD medication — a task currently only done by paediatricians, neurologists and psychiatrists, who often have lengthy wait lists and charge high fees.
Queensland has had a similar system in place since 2017 for patients aged between four and 18, while New South Wales, Western Australia and South Australia have also committed to rolling out a GP-led ADHD program for young people next year.
"We know there are a lot of people that are really concerned about the access to diagnosis and the access to prescriptions for ADHD,"Dr Cidoni said.
"So, we're really mindful that we need to do something to address the issues that are out there."
In late 2023, a Senate inquiry into ADHD recommended the development of uniform prescribing rules be expedited to ensure consistency between all jurisdictions.
But Dr Cidoni said it had become evident that achieving that recommendation could take years, and ACT Health decided it could not afford to wait.
GPs are getting new powers to diagnose ADHD and prescribe medication. (ABC News: Maren Preuss)
"We don't want to wait for that because we think the need is there now," Dr Cidoni said.
The pilot program is slated to start as early as December but no later than January next year, following stakeholder consultation.
Canberra GPs already have some prescribing arrangements, which allow them to prescribe ADHD medication for adolescents for two years and adults for three years, as recommended by a specialist.
"That is really restricted by what the specialist has determined or the specialist has outlined,"Dr Cidoni said.
"What we have planned is two streams — one stream will be for GPs to be able to do the actual diagnosis and prescribing, and the other stream will be to do the prescribing but on a much broader level than we have now.
"So, I think we're looking at quite a significant change."
The pilot program will allow around 50 doctors to prescribe ADHD medications like Concerta, Vyvanse and Ritalin. (ABC News: Adam Kennedy)
General practitioners will have to apply to take part in the pilot program and, if approved, will need to complete comprehensive training before taking on patients.
There will be clinical supervision by a specialist and a requirement for a GP to refer complex patients to either a paediatrician, psychiatrist or neurologist.
"We've already scoped the level of interest in our GPs in the ACT so we're thinking there would be around 70 to 100 that might be interested in participating in a program like this," Dr Cidoni said.
"A smaller proportion in the diagnosing and treatment arm, and then a larger proportion in the prescribing arm.
"And if we get the parameters right, in terms of the appropriate education, psychiatrist oversight and access to ongoing support, I believe we can do it safely.
"We need to recognise that we can't meet this need through our private practitioners so we have to have a different way of managing it, but I wouldn't be doing this if it wasn't safe."
Weight lifted from paediatricians' shoulders
Dr Kim Bland says the pilot program is needed to release the excessive pressure on Canberra specialists. (ABC News: Michael Barnett )
When paediatrician Dr Kim Bland was told GPs would soon take on more of the ADHD workload, she breathed a sigh of relief.
And Dr Bland suspects specialists across Canberra will do the same when they hear the news.
"This is coming as a real relief to paediatricians and to families, it is very much needed,"Dr Bland said.
"Even with my books closed and that being well-known, we are still getting daily inquiries from families not just looking for care like they would for other medical conditions, but being in crisis.
"Not just asking for medical care, but asking for help and rescuing because they're really in a desperate and dire situation, and that's the difference with these children."
Dr Bland said every aspect of life is affected for a child living with undiagnosed ADHD, especially their education and self-esteem, plus the pressure on parents can lead to family breakdown.
She said turning those families away is one of the most difficult parts of her job.
"For parents, it's one thing to not know what they can do for their children but it's another to know it's right there, help is available, a diagnosis is available and all the support that comes with it, but they can't access it," Dr Band said.
And for her, to know there will soon be a team of competent GPs to refer those families to feels like a weight being lifted.
"It takes some of that weight that is sitting on top of us and contributing to our burnout away. It really is a pressure valve for us,"Dr Bland said.
Confidence in GP take-up
Dr Kerrie Aust says it's important people can access timely care for suspected ADHD. (ABC News: Matt Roberts)
Dr Kerrie Aust, the ACT president for the Australian Medical Association, said it made perfect sense for general practitioners to play a more significant role in the ADHD space.
She is hopeful she will get approval to be among the group of GPs able to diagnose ADHD and prescribe medication for the condition.
"We are seeing an increase in young people and adults coming in to have discussions about whether they might have ADHD and it's really important they access care in a timely manner," Dr Aust said.
"While psychiatrists and paediatricians have really been trying to step up into that space, I think this is a good example where GPs can work to the full of their breadth of scope and get involved in the diagnosis and management, especially where those cases are relatively straightforward and we've got proven treatments."
Dr Aust said she was confident the take-up by general practitioners would be strong enough to have an affect on patient care.
Dr Kerrie Aust believes there will be stong enough take-up of the pilot by general practitioners. (ABC News: Romy Stephens)
"Every little bit counts — if one doctor can see two or three new patients a week, then that's a huge change to the backlog," Dr Aust said.
"It also creates space for the paediatricians and psychiatrists to focus their attention on some of the more complex diagnostic cases, or where we're having trouble managing the medications."
But she warned potential patients not to expect a diagnosis within a standard quarter-hour consultation.
"There will still need to be patience around a diagnostic assessment,"Dr Aust said.
"It's not going to be a case of booking the 15-minute appointment and coming in and walking out with a diagnosis — it will still take time and patience, and we may need to try a few things before we get it right.
"But I do think being able to access regular care with your GP is a really positive step."
Potential patients have been warned not to expect an ADHD diagnosis within a 15-minute GP appointment. (ABC News: Luke Stephenson)
Pilot age limit not yet clear
There will be an age limit for patients being seen as part of the pilot, with Dr Cidoni still to decide whether 18 or 26 is the most appropriate option.
Dr Bland said she would urge him to extend the age to 26.
"A lot of paediatricians are looking after children after the age of 18 because there is no one to transition their care over to,"Dr Bland said.
"Usually by the time they're an adult, they're on a very stable dose, they've got a very good support around them, they know when they need to speak to their therapist, they know when they need to adjust their dose.
"And if anything, it's slightly more simple diagnosing past that age, so that would be a group I think would benefit greatly from seeing their GP."
Dr Kim Bland believes the patient age limit for the pilot program should be 26. (ABC News: Adam Kennedy)
Dr Aust agreed, adding she had seen a growing gap in care for patients aged between 16 and 24.
"Often, young people who have been diagnosed when they were in primary school, they may have been lost to follow-up for a long period of time and we don't have access to their previous diagnostic records," she said.
"And in those cases, it's both challenging and expensive to have those assessments.
"We really find that they run into trouble as they get into the workplace or they're attending university, and that's a group that I would really love to see supported."
Both doctors agreed that it should be a question of complexity, not age, but acknowledged the pilot program had to start with some parameters in place.
Deraine Jackson says school would have been a completely different experience for Phoebe if they'd had access to a diagnosis sooner. (ABC News: Ian Cutmore)
When Ms Jackson considers how Phoebe's experience could have been different had their diagnosis come from a general practitioner, she is brought to tears.
"If we'd been able to go to a GP and they could have done tests the moment the anxiety and depression started, it would have been a totally different journey," Ms Jackson said.
"School would have been a completely different experience for Phoebe, I would have parented differently — so much would have been different.
"And it would have been so much more affordable. The cost is a really big impact — it is costing thousands of dollars out-of-pocket for these specialist appointments.
"It's obviously too late for us, but maybe there's a little undiagnosed girl in Year 7 who can be picked up by her GP and find life a much easier journey as a result."