GPs in WA can now diagnose and prescribe for ADHD

Some 64 GPs have completed the first of its kind training aimed at improving access to care and reducing demand for specialist services, including paediatricians and psychiatrists.

The GPs will be able to assess ADHD in patients aged 10 and older and be able to prescribe stimulant medications.

More than a third of the newly trained GPs are based in regional and rural WA, where patients face significant barriers in access to specialist services.

The program was designed by the RACGP and Australasian ADHD Professionals Association and supported by $1.3 million funding from the state government.

Participants were required to complete two foundational online modules covering ADHD identification and pharmacological management.

They then took part in clinical discussion forums alongside experienced paediatricians and psychiatrists to understand how ADHD consultations worked.

Among those who completed the training was Armadale-based GP Dr Lewis MacKinnon. He said the training formalised the holistic work already being undertaken by many GPs.

“Stimulants are only part of treatment, the case finding and healthcare navigation role, adjustment to diagnosis and the fine tuning of their mental health already happens with GPs," he told Medical Forum.

“The step forward is really in understanding and respecting the specifics of stimulant prescribing, but ADHD diagnosis and management goes quite far beyond that.

“It’s a bonus that patients can now see a GP for that as opposed to having that part of their health syphoned off into a psychiatry or paediatric consultation.”

GPs who took part in the program had to make a case as to why they should be selected. Working in with patients from a lower socio-economic background with an unmet need in this area was one of Dr MacKinnon’s main drivers.

“There’s micro clusters in my local area and when you compound that with access to diagnosis costing patients upwards of $2000 for a child and more for an adult, my community was really being left behind.

“The consequences of several generations of untreated ADHD is that people become more likely to have challenges with maintaining family cohesion, self-medicating with alcohol or drugs, or struggling to complete secondary education.”

Dr MacKinnon said it had been incredibly satisfying to be able to bring ADHD services into the community and make it more accessible to his patients.

There were boundaries highlighted in the training that would remain outside of GP scope, including children under 10 years, complex comorbidities such as psychosis, bipolar disorder, or substance use disorder, significant intellectual disability, high-risk cases involving self-harm, and atypical medication responses.

These cases will require referral to non-GP specialists in line with current practice.

There was keen interest from GPs to take part in the program when it was launched late last year. Despite there only being 65 places available, more than 400 applied to take part.

The state government confirmed additional training places will be available in the coming months.

Chair of the RACGP WA ADHD working group Dr Tim Leahy said the program was delivered successfully with candidates being selected from a good representation of WA.

“The doctors have had plenty of opportunity to learn, reflect, practice, ask questions, explore and talk to each other and experts. That’s good practice and I believe we can be proud of what we’ve delivered," he told Medical Forum..

“As a graduate of the program myself, I have learnt a lot and I feel a lot more confident to diagnose and treat straightforward cases of ADHD, as well as offer comprehensive assessment – not just a sole focus on prescribing.

“Primary care is the foundation of the Australian healthcare system, so it’s an ideal place to offer care for something that is common and affects different members of the family in different ways. GPs are ideally placed for early detection, ongoing monitoring and ongoing care throughout different stages in life.”

The training is being supported by an expansion to wraparound services provided in the state, including a telephone and webchat information service, group therapy programs, school-based programs, and peer support groups for people affected by ADHD.