Qld GPs will soon be able to diagnose and treat ADHD. Is that a good thing?

“He came back and said, ‘Yeah, I think you have combined ADHD,'” Campbell says.

She then visited her GP for a referral to a psychiatrist and to discuss plans for co-prescribing: “But the doctor didn’t want to refer me…until I got the full report of this ADHD assessment.” [from the psychologist].”

There was further back and forth until Campbell saw a psychiatrist in July, which cost $1075 in cash.

After further difficulties with GPs, he found a doctor in Windsor in August who would prescribe medication.

“I now have clarity about why I am the way I am about certain things,” he says. “I just needed my brain to wear glasses; that’s literally how I feel.”

Change is coming for Queensland residents

Campbell knows of people waiting up to a year to make an appointment with a practitioner who can test and prescribe for ADHD.

He also knows that even without long wait times, the cost can be prohibitive.

Nicholls described the move to allow specialist GPs in Queensland to treat adults with ADHD as a “game changer” that would increase access to services and better utilize the skills of GPs.

ADHD affects an estimated 1 million Australians, including more than 530,000 adults.

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Until now, the disorder was diagnosed by specialists such as psychologists, psychiatrists and paediatricians (for children), usually under the guidance of a general practitioner.

Leading bodies, including the Royal Australian and New Zealand College of Psychiatrists, have broadly backed Queensland’s proposal, with the caveat that GPs need specialist training and should continue to work with psychiatrists to treat ADHD patients.

President of the Royal Australian College of General Practitioners, Dr. Michael Wright agrees with a collaborative approach, but says patients need access to higher discounts for it to work.

“ADHD care is complex [and] “We really need to increase Medicare rebates, especially for these longer consultations, to allow for more case conferencing,” Wright says.

Wright says most GPs already have the necessary skills and those who are not confident are helped.

Overdiagnosis and drug abuse

Queensland’s initiative, lauded as a win for patients like Campbell, has not gone without criticism.

Diagnosing ADHD can be complicated due to its overlap with other conditions, says a Brisbane-based GP who spoke to this imprint on the condition of anonymity due to sensitivities surrounding the treatment of developmental disorders.

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These include autism spectrum disorder, depression, anxiety, substance use disorder, and sensory processing disorder; An estimated 65 percent of people with ADHD also experience at least one comorbid condition.

The GP says the process of defining ADHD is based on “vague inclusion criteria”, which can lead to an increase in misdiagnoses. They also fear that this change will trigger a potentially unethical increase in the number of healthcare professionals providing access to diagnosis and medicine in exchange for payment.

“It’s being sold as a cheaper option to come and see the GP, but the market will certainly adapt to this so GPs will charge more because it’s a sought-after service,” they say.

“The GP market is already fragmented; you won’t find any GPs with vacancies at the moment – so you’re going to create business models where they’re coming out that say they can do it, but it’s going to cost more. Then there’s pressure on the GP to make the diagnosis.”

Professor Bolanle Ola, a psychiatrist with experience in treating and diagnosing ADHD, says the psychiatric community has raised similar concerns about misdiagnosis and overdiagnosis.

“People are also concerned about short consultation times from GPs, which can encourage a quick-fix mentality and potentially lead to over-prescription of stimulants with potential side effects,” he says.

From 2013 to 2020, the number of Australians diagnosed with ADHD more than doubled; Approximately 470,000 people were prescribed medication in 2022.

Wright says he has not received negative feedback from members since the proposal was announced, and notes that not all GPs will want to treat ADHD patients.

“Things like adding long-acting contraceptives; some GPs do this more, others feel they’re not familiar with it and don’t do it,” he says. “I expect ADHD prescribing to be similar; not everyone will do it.”

ADHD care is advancing

Campbell continues to see his GP in Brisbane’s north end to manage his medication and has returned to the psychologist who made his initial diagnosis under a supported mental health plan.

“You go through the five stages of grieving for your past life… [but] “I’m coming to the end and I can see the light,” he says.

“This is my life now and it’s wonderful.”

Ola says care “must be multidisciplinary and individualized, tailored to patients.”

“I think patients need to be informed about the scope and limitations of GP-led ADHD management and the potential need for specialist involvement,” he says.

With the changes due to be implemented in just over a week, Wright urges people to discuss their attitudes towards ADHD treatment with their GP and “don’t expect too much change”.

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