Dr David Chinn: health policy advisor on the growing concerns surrounding GPs being able to treat ADHD

ADHD New Zealand is echoing calls for caution when it comes to GPs treating the condition.

GPs will be able to start medical treatment next year for those affected. 

The College of Psychiatrists says GPs should only be included if they have accredited training and clear referral and escalation pathways. 

Dr David Chinn is part of a team of experts who advises on health policy, and he says it's been hard for people to get access to proper assessments - but it's important to do this in a careful, considered way.

"It's important that this is being done in conjunction with adequate training, guidelines and also support from other practitioners as well." 

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Episode Transcript

Speaker 1 (00:06):
You're listening to the Sunday Session podcast with Francesca Rudgin
from News Talks edb Okay.

Speaker 2 (00:13):
The Royal Australian and New Zealand College of Psychiatrists so
calling for caution ahead of a change to ADHD diagnosis
and treatment early next year as February first GP. As
of February first, GPS and nurse practitioners will be able
to diagnose and treat ADHD in those over eighteen. Spokesperson
Doctor David Chin represents the College of Psychiatrists in a

(00:33):
group that advises on health policy and he joins me, now,
thanks so much for your time this morning.

Speaker 3 (00:38):
David, good morning, good morning, Thanks for having me on.

Speaker 2 (00:41):
Talk me through where you sit on this. What are
your concerns ahead of this change next year.

Speaker 3 (00:47):
Look, I think it's important to be clear that ADHD
has been an underrecognized condition for quite some time and
it's been really hard for people to get access to
timely assessments across the age span, really and so as
part of a wider group, we've been working on a
greasing access, particularly for those over eighteen who this has

(01:09):
been harder for to achieve and we need to make
sure this is done in a careful, considered way, so
as you know, the changes will take place, particularly for
those over eighteen, for notice practitioners and gps to be
able to initiate stimulant medication diagnosed treat ADHD, which is
a good thing and it's important this is being done

(01:31):
in conjunction with adequate training guidelines and also support from
other practitioners as well.

Speaker 2 (01:37):
So will all gps be able to do this? You
mentioned training? There will gps have to take on some
specialized training in this area.

Speaker 3 (01:45):
Yes, there'll be additional training available to them and there
are various packages being worked out at the moment. Our
college is has put together a particular certificate in Mental
Health Care for primary practitioners that they're hoping will be
available soon. But there's also other packages of training as well.
And it will really be gps who feel comfortable to

(02:09):
undertake this role and who've done some additional training who'll
be doing these assessments and starting medication for people and
who that's suitable.

Speaker 2 (02:19):
And David, ideally we're not diagnosing in a fifteen minute appointment,
are we?

Speaker 3 (02:24):
Absolutely? Absolutely so. The consensus document we've worked upon suggests
that this should be a comprehensive assessment. It's likely in
the order of one, two, up to three hours in total.
That's not that long in a room with somebody that
might be the GP, or then as practitioner liaising with
say somebody's parents, or reviewing old record to try to

(02:48):
feel that there's a robust, consistent diagnosis of ADHD for
that person.

Speaker 2 (02:54):
Okay, so are we ready to safely make these changes
come the first of February? Will GPS be ready to
take this on?

Speaker 3 (03:01):
I think it's important to know that gps are highly
specialized practitioners and they manage a number of different complicated conditions,
and I think within the general practice there will be
a dimension into dimension in terms of some who feel
more ready than others, and I would expect it will
be those who are more ready, who feel that they

(03:22):
have the expertise and who undertake this additional training to
do this. There will be some who feel that this
is not something they can feel comfortable at this point
in time, and it's important that they don't take that
on unless they do feel able to do this additional role.

Speaker 2 (03:36):
David, do you have any other concerns ahead of the
move to this model? Is there anything else you'd like
to see tweaked when it comes to implementing.

Speaker 3 (03:44):
It, yes, I think as well as the training, the guidelines,
the support from other practitioners, it's important that there are
clear referral pathways for gps that if there is additional complexity,
they don't feel that they're undertaking roles or assessments that
they feel or beyond them, and that specialists are able

(04:04):
to fulfill that role. It's also like that with undertaking
these assessments, additional co occurring conditions might be recognized, and
again it's important that the GP organ as practitioner recognizes
that this is either within or outside of one's scope
and asks for specialists to get involved at the appropriate time.

Speaker 2 (04:23):
That's really important because I think anybody out there who's
hidden experience with an ADHD diagnosis will know that it
often comes with other things. It's not often now just
on its own, is it, David?

Speaker 3 (04:33):
Absolutely? Absolutely. We know that many conditions can co occur
with ADHD or mimic ADHD as well, so the assessment
has to be comprehensive to make sure that ADHD feels
like the right fit, but often does co occur conditions
such as autism, anxiety disorders, substance use disorders can all
co occur with ADHD need to be recognized and treated
well in their own right.

Speaker 2 (04:55):
You mentioned David earlier on you know it's been had
to get access to get assisted in things. In terms
of meeting the demand, Is this the best way to
meet it?

Speaker 3 (05:04):
I think it's one of a package of ways to
meet it. I think it's important to recognize that there
are certain groups who in whom it's been particularly hard
to access treatment. We talk about there's evidence that for
MARI they've been disproportionately affected, females have been disportantly underdiagnosed,
and across adult and child and youth services, it's been

(05:26):
particularly harder for adults to get assessments as the landscape
currently sits. So this is certainly one way to do that,
but we'd advocate additional ways as well. I think it's
also important to recognize that ADHD, although medication can play
a really important role, there are other non medication approaches
to support people with ADHD as well, and it's important

(05:48):
we continue to try to provide those so there's a
comprehensive package and people have choice about the kind of
approach they'd like to take.

Speaker 2 (05:56):
What role do psychiatrists need to play in ADHD diagnosis
and this new model?

Speaker 3 (06:03):
So I would still expect psychiatrists and mental health practitioners
to undertake more complicated assessments, those that seem to be
beyond the scopes of nurse practitioners or gps, and as
our colleagues undertake these newer roles, supporting them to undertake
these roles is really important. So I would expect that

(06:26):
people work with locally based nurse practitioners and gps to
support them to do this, whether that's formalized peer support
groups or even more informal relationships with the primary primary
care practitioners in one region.

Speaker 2 (06:41):
Doctor David Chin, thank you so much for your time
this morning. Really appreciate you talking us through that. So
that gives you a bit of an idea of what
to expect on Febry first, especially if you have been
trying to get a diagnosis up to now, you might
need to start looking for a GP who who has
put their hand up and is doing the training.

Speaker 1 (06:58):
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