15-07-2025
GPs welcome ADHD reforms but say cost and prescription barriers remain
When GP Naomi Rutten found out she would soon be able to diagnose patients with attention deficit hyperactivity disorder (ADHD), she was "delighted".
For a long time, the diagnosis of ADHD has largely been restricted to psychiatrists and paediatricians.
Dr Rutten specialises in mental health in the South Australian town of Gawler, about an hour's drive north of Adelaide.
She has a personal investment in neurodivergence, with three neurodivergent children and her own diagnosis of ADHD.
"I've got a half a dozen patients who can't afford the assessment, so [my patients and I] are super excited," said Dr Rutten, who is also president of the Australian Society for Psychological Medicine.
"They'll be able to get diagnosed, trial some medication, and if it helps improve their function, it's going to make a world of difference to their capability to work, parent and be well in themselves."
South Australia, where Dr Rutten practices, is one of several states to recently announce changes to ADHD management, which will allow GPs to diagnose the condition and, in some cases, initiate medication in the future.
Changes in South Australia come into effect next year, while governments in NSW and Western Australia have committed to training up ADHD "specialist" GPs, and there is bipartisan support in Tasmania ahead of the state election for GP-led ADHD care.
But with so much policy change afoot, doctors have warned that patients may still face out-of-pocket costs for assessments, as well as barriers to accessing medication, without further reform.
One of the main barriers to ADHD assessments is cost, with some patients being charged thousands of dollars for appointments with psychiatrists, and others simply being priced out.
Dr Rutten says patients will probably pay much less to see a GP for an ADHD assessment, but warns these consults are unlikely to be bulk-billed.
That's because ADHD assessments require longer GP consultations, for which doctors receive a smaller reimbursement (from the government) than if they provide multiple, shorter appointments.
For example, if a GP sees 10 patients in an hour, for six-minute appointments each, they earn around $690 in rebates. But if they see a single patient for one hour, they receive $158.
As a result, Dr Rutten says GPs are financially disincentivised from providing longer appointments and more comprehensive care, and when they do, are forced to charge patients higher out-of-pocket fees.
At her own clinic, Dr Rutten's patients pay $135 out of pocket for a 70-minute appointment. She says with a thorough ADHD diagnosis likely to take two or three long appointments, patients could face up to $405 in fees.
In 2023, the federal government tripled the incentives GPs receive for bulk-billing patients.
From November, these incentives will be applied to consultations with all Australians (not just pensioners, concession cardholders, and families with children). GP practices that bulk-bill every patient will also be eligible for an additional payment.
But Dr Rutten says that for GPs to bulk-bill ADHD assessments, they need to be better reimbursed for longer appointments.
The Royal Australian College of General Practitioners (RACGP), which welcomed the government's bulk-billing changes earlier this year, has also advocated for increased rebates for longer consultations, as well as an increase to mental health-related Medicare items.
ADHD Foundation director Christopher Ouizeman also wants to see GPs better compensated for the work of diagnosing and treating ADHD, to help address the current "bottleneck" of people trying to access affordable care.
"We think there should be some formalised structures in place to prevent the general public from being overcharged, and certainly to ensure that GPs are properly incentivised," Mr Ouizeman said.
But in order to improve affordability and accessibility of ADHD care, he says more investment is needed in public psychiatry and paediatric services.
It's an issue Tim Jones, a GP practising in rural Tasmania, is also passionate about. He spent two years working on a pilot program at Royal Hobart Hospital to try and improve access and timeliness of care for children with possible ADHD.
Dr Jones said the program was successful — dropping wait times for kids from two years down to less than four months — but was cut short due to lack of funding.
He believes a similar model, in which specialist GPs are placed in public outpatient clinics, could be implemented to improve access to ADHD assessments for vulnerable populations.
"The only way I can see the equity gap being fully addressed is getting more GPs working in collaborative partnerships in public healthcare services," he said.
"Private GPs and paediatricians have worked together as long as we've existed, but that has not been enough to meet the needs of the majority of our population."
Another issue consumers currently face is difficulty accessing stimulant medication when travelling between states and territories.
In Tasmania, patients are unable to get scripts filled if they are issued interstate, although there is bipartisan support to change this after the upcoming election.
Elsewhere in Australia, scripts can be filled interstate, but this is an onerous process, given stimulant medications (the most common medicine used to treat ADHD) are classified as schedule 8 or "controlled" drugs.
John Kramer, who chairs the RACGP's special interest group on ADHD, autism and neurodiversity, argues stimulant medication should be reclassified as a schedule 4 drug, with less stringent legislative controls.
Schedule 4 drugs are considered less likely to lead to misuse, abuse or dependence than schedule 8 drugs, but still require more stringent controls than regular prescription medication.
Dr Kramer says re-classifying stimulants would mean "people can move freely from state to territory and back again, and their prescriptions would be valid everywhere".
He argues any potential risks could be managed through Australia's real-time prescription monitoring service, which allows GPs to see how often a patient gets their medication dispensed, and how many repeats they have left.
However, others are more cautious.
Dr Jones argues that stimulant prescribing — and any change to it — needs to be carefully considered in adults, as adverse effects can be "significant".
The ADHD Foundation would also take a "very conservative position" on any re-classification, Mr Ouizeman said.
"I'm not sure it's the right thing to do at this stage," he said.
"Let's see how it goes with the existing [reform] frameworks, and if it's something that should be revisited later perhaps."
Doctors in some states are also waiting on information about how GPs will be able to prescribe stimulant medication going forward.
While regulations vary from state to state, GPs are generally required to "re-apply" for the right to re-prescribe stimulant medications (or make changes to prescriptions).
Currently, in South Australia, GPs can prescribe stimulant medication for patients who have been diagnosed by psychiatrists, but to do so, must apply for approval to the Drugs and Dependency Unit.
When approval is granted, it is generally only for a limited period, such as 12 months. Once this period is up, Dr Rutten must send patients back to a psychiatrist for review, leaving them further out of pocket.
She hopes the shift to allow GPs to diagnose will circumvent this problem, but these details are not yet available.
In NSW, GPs who have undergone training will be able to resupply ADHD medication to patients (without seeking re-approval) from September, with some able to initiate medication, though it's unclear when this will begin.
RACGP vice president Ramya Raman says any changes to ADHD prescribing rules will be finalised at a state and territory level, but working towards a national approach is ideal.
"I think [prescribing changes] will be part of the reform and progress that we are making," she said.
"There have already been some changes in WA, and there will probably be [further changes] moving forward if we're working towards a national consistency model."
