A significant transformation in the diagnosis and management of attention-deficit/hyperactivity disorder (ADHD) across Australia is poised to place greater responsibility on general practitioners, yet medical professionals are raising critical questions about the readiness of Medicare to support these changes.
Expanding GP Roles to Improve Access and Reduce Wait Times
Under new state-led initiatives and investment, Australians will increasingly have the option to seek ADHD diagnoses and ongoing treatment through their local GP, rather than enduring lengthy waits of up to a year to consult with a psychiatrist. This shift aims to dramatically enhance accessibility, particularly for families in rural and remote areas where specialist services are scarce.
Victoria Leads with Formal Training Framework
Dr Anita Munoz, a general practitioner and spokesperson for the Royal College of GPs, highlighted that Victoria is implementing a structured framework to ensure GPs receive proper training before diagnosing ADHD. She emphasised that diagnosing ADHD is not a simple process, requiring thorough assessments and time.
"We recognise that the diagnosis of ADHD isn't simple, it takes time, and it requires a thorough assessment," Munoz stated. "We will be putting in place a framework for GPs to undertake the training to do that appropriately. And we will also be undertaking training so that GPs can continue to prescribe when they're co-managing with a psychiatrist colleague."
Inconsistent State Rules Create Patient Frustrations
While Victoria formalises its approach, regulations vary widely across Australia, leading to a patchwork system where patients face different healthcare journeys based on their location. In some states, GPs can diagnose ADHD, while in others, they are limited to treatment only.
"It is a bit frustrating that in our federated system, a patient can have a totally different health journey depending on what state that they're in," Munoz remarked, pointing out the inconsistencies that leave patients navigating disparate pathways.
Medicare Funding Concerns and the Challenge of Complex Consultations
Despite strong uptake in some regions, such as Queensland where around 500 GPs have completed ADHD training without formal mandates, a major concern revolves around Medicare's ability to fund longer, more complex consultations required for ADHD assessments.
Funding Described as 'Woefully Inadequate'
ADHD assessments often involve multiple appointments and significant time, which Munoz warned is difficult under current Medicare funding arrangements. "I don't see that it's going to be possible for GPs to do very long consults only on what's available with Medicare funding," she cautioned. "We know that Medicare funding that's on offer from the federal government is actually woefully inadequate when it comes to taking a good amount of time with patients."
While GP-led care is expected to reduce costs compared to specialist fees, patients may still incur out-of-pocket expenses if comprehensive assessments are necessary, highlighting potential financial barriers.
Potential Benefits and Ongoing Challenges
The reforms are anticipated to yield the most substantial benefits in rural and remote communities, where access to psychiatrists is severely limited. However, the success of this shift hinges on addressing key issues:
- Ensuring consistent training and standards across all states to eliminate geographical disparities.
- Securing adequate Medicare funding to support the time-intensive nature of ADHD consultations.
- Balancing improved access with the risk of increased out-of-pocket costs for patients.
As Australia moves towards a more GP-centric model for ADHD care, the healthcare system must navigate these challenges to deliver effective and equitable treatment for all Australians affected by this condition.
