There is hope that more GPs will come on board to train in ADHD diagnosis. Photo: 123RF
Fewer doctors than you might think are offering ADHD diagnosis and prescription services, despite rule changes at the start of the month.
There are hopes more will come on board, but for now, industry leaders say GPs could be slow to train up in an area most haven't worked in for decades.
Luke Bradford, the president of the Royal New Zealand College of General Practitioners, told RNZ he would put the number about 15 to 20 percent currently.
"But that will steadily grow," he said. "In my own surgery, for instance, the GP who wants to do it has identified that she wants to do it, she's been on a couple of courses, and she feels she'll be in a position to start in a couple of months."
GPs were well placed to manage this kind of medication, he said, often having long-term relationship with patients.
But their ability to prescribe ADHD drugs was removed in 1999, amid fears people were misusing them.
Bradford explained that, while doctors were technically allowed to a range of things, from minor surgery to skin cancer assessments to menopause medication, they had to recognise their own limits - and it would be negligent for them to do something they weren't trained in.
While one in six doctors didn't sound like many, it added up, he said.
"That is massive numbers - if you look across the nation, we've got 6000 GPs and the prevalence of ADHD is somewhere around 5 percent, of which we're already managing 2 percent.
That equalled, conservatively, about 750 GPs for about 250,000 people with ADHD - of which less than half were on medication.
These rule changes were meant to provide more people with access to medication, to help close that gap.
Bradford said he expected GP numbers to grow, as more doctors took up the courses and more new grads emerged with an interest in the field.
Some 600 attended one of the college's eight-week courses late last year.
Dr Kim Hurst, a GP in Whakatipu and clinical director at Green Cross Health, was one of them.
"I think the thing that surprised me is the uptake across my peers and colleagues has been lower than I expected, and I think that is largely due to the pressure that primary care is under at the moment."
She compared it to the introduction of insulin prescription services
"Some of us felt way more comfortable doing it than others," she said. "That transitional period took probably six to twelve months, and now that it's bread-and-butter, we wouldn't even think about sending a patient who needed to start insulin to hospital."
Now, her team was working collaboratively to assess people for ADHD, with any doctor able to start the conversation, and then match the patient with a GP within the wider company who was happy to diagnose and prescribe.
"What I really didn't want to see was kind of a sign up on the door saying, 'We don't do ADHD," Hurst said. "I think that's a disappointing message for patients with neurodiversity to hear."
"We know ADHD is an under-diagnosed condition, and has a significant social and economic cost burden associated with it, so we really wanted to ensure we had open doors for that initial assessment, and then a means to navigate to GPs and nurse practitioners who have done the additional training."
She said she had been heartened to see how many psychiatrists were approaching GPs to offer their advice or support.
Lewis Roscoe, who lives in Stanmore Bay, was one of those patients who had turned up at an appointment in early February, and left disappointed.
He got a diagnosis from a clinical psychologist, at a cost of $1500, in November.
He was told: "You can go to a psychiatrist, get them to prescribe you the medication, but that's about $800, and so since we'd literally just coughed up $1500 already, it wasn't really our go-to."
But on hearing GPs would soon offer that service, he booked an appointment for February.
He even checked in multiple times to make sure his GP could prescribe that medication.
But, last week, he left his double appointment after only 10 minutes with a $150 bill, and a referral to a psychiatrist - which was what he'd been trying to avoid.
"I mean it's still going to be cheaper than 800 bucks, but I guess if you want to compare price to stress levels, it would be nicer if it was a lot more clear-cut - see one person, get prescription, go to chemist," he said.
He was still going to pursue a prescription through his GP, but if that didn't work out by the end of the month, he'd start looking elsewhere.
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