Until now it’s been the domain of psychiatrists and psychologists only, but from February 1, GPs can diagnose and treat ADHD. With soaring demand, this could improve access – but doctors are warning it’s no quick fix.
“You’re a distraction to others and yourself.” Growing up, Christchurch woman Pamela often saw these words on her school report cards. But it wasn’t until 2020, when she was at uni, that she started wondering whether she might not be eminently distractible – and instead have ADHD.
Getting a diagnosis was straightforward, if expensive. She rang around private psychologists and found one offering assessments. The appointment took an hour and cost “about $340, $350, something like that”. A follow-up report cost another $300. Pamela feels lucky she got an ADHD diagnosis when demand was lower; she’s heard of people paying upwards of $1,000 for a diagnosis in Christchurch more recently. The report from the clinical psychologist was sent to a psychiatrist, who had the special access number required to prescribe ADHD medication.
Pamela’s process of receiving an ADHD diagnosis is pretty standard for adults. Assessments can only be done by clinical psychologists or psychiatrists (paediatricians can assess and diagnose children). Waiting lists in the public system are long, so those who can afford it go private, but there will still often be a very lengthy wait for an appointment. Only psychiatrists and paediatricians can initiate prescribing ADHD medication, but GPs and NPs (nurse practitioners) can continue prescribing on written recommendation from the specialist who initiated.
From February 1, that changes. GPs and NPs will now be able to assess people with suspected ADHD, make diagnoses and prescribe medication (methylphenidate, which is sold under brand names such as Ritalin, Rubifen and Concerta, dexamfetamine and lisdexamfetamine). “GPs have been prescribing treatment, but only with the endorsement of a psychiatrist who has reviewed an [ADHD] assessment,” says Ben Beaglehole, a psychiatrist and University of Otago lecturer who has researched under-treatment of ADHD in New Zealand.
But GPs are warning that the change will not be an instant solution for people seeking ADHD diagnosis or treatment. “It will be a slow burn, not a magic bullet to increase diagnoses,” says Angus Chambers, GP and chair of the General Practice Owners Association. With general practices often “snowed under” managing patients with complex, overlapping, chronic health conditions, ADHD diagnoses will just be another thing on the list.
“We need to lower people’s expectations – you can’t walk in saying ‘I have ADHD, can I have a prescription?’ and walk out with a prescription for amphetamines,” Chambers says. A diagnosis may take multiple appointments. The service is unfunded, meaning the government won’t subsidise GP appointments for ADHD diagnoses. It’s also optional; GPs can choose whether to offer the service, and many may want to do additional training before deciding whether to provide it at their clinics. Because an ADHD assessment takes time, the change may direct GP capacity away from other work. Patients unable to access early interventions from their GPs could end up in hospital, costing the health system more.
The broader context is a rapidly growing demand for ADHD diagnoses as knowledge and understanding of the condition increases, particularly in previously neglected groups like women and girls. “I’ve seen a huge interest in assessments, and that interest hasn’t been met by public providers,” says Beaglehole. He and other researchers analysed prescription rates for people with ADHD between 2006 and 2022. There was a 10-fold increase in ADHD prescriptions for adults during that time.
Demographic data is telling. “Most psychiatric disorders tend to cluster to socio-economic disadvantage,” Beaglehole says. That isn’t the case for ADHD – a possible sign that only those who can afford private assessments are getting treated. “That makes me think that more people who can pay for their assessments receive treatment.” While treatment has increased, international ADHD prevalence data shows that many people likely aren’t receiving treatment that could help them.
One reason ADHD prescriptions have been tightly restricted is the medications can be used recreationally. “When I first got diagnosed, people asked me ‘are you going to sell your pills?’” Pamela says. While most of her friends were joking, the ‘street value’ of medications may add to demand for prescriptions. “There has to be tight oversight of a treatment which is a recreational substance and has the potential for misuse,” Beaglehole says.
The upside of making prescriptions available directly through GPs is easier access, even though not all GP clinics will provide this service from the get-go. However, the downside is that stretched GPs may be stretched further. “It’s unclear if people will still get thorough assessments, it depends what GP practices do,” Beaglehole says. Many may still rely on private psychologists’ reports for diagnosis, which will not mean a significant cost reduction for patients. Beaglehole is concerned there may be more misdiagnoses, or pressure from patients for particular medications.
Even if a diagnosis is correct, medication isn’t an instant fix. “I had to trial medication throughout 2021 and 2022 while finishing uni,” Pamela says. She tried different strengths of pills, long-acting and short acting medication, and kept returning to her GP and an ADHD specialist until she found a combination of drugs and timing that worked. There are still side effects, like a loss of appetite and trouble sleeping. “Even if I time [my afternoon dose well] I have to work a bit harder to fall asleep,” she says.
There’s also a global shortage of ADHD medication, one reason Pharmac delayed the prescribing changes until 2026. New Zealand is not the only country that has seen a massive increase in demand for ADHD treatment in the last two decades, as more people become aware of the condition and seek help. “Lots of people went through school being told they were naughty or disruptive, and now they’re adults realising they could have ADHD,” Chambers says. For others who have the “inattentive” form of the condition, it might be difficulties with time management and organisation as an adult that causes the penny to drop.
Ultimately, Chambers says, changing who can diagnose and prescribe medication for people with ADHD is “a bureaucrat’s way of changing the system with the stroke of a pen”. Demand might shift from psychiatrists and psychologists to GPs – but so many people are seeking ADHD treatment that it won’t be an instant fix, especially in a global context of constrained drug supply chains. Beaglehole suspects that the private system will continue to be a go-to for people who can afford it, and that psychiatrists in the public system may still have long waiting lists for people with ADHD. The condition often coexists with other troubles, like alcohol and drug dependency or anxiety and depression.
“We’ve fixed a lack of resourcing in the public system by having more people in the primary sector assess for ADHD,” says Beaglehole. “Ideally we also fix that with more resources for specialist mental health, and more paediatricians. But maybe that’s unrealistic even to say.”
