Q: These changes apply to prescribing stimulant medicines, how will this impact diagnosis? Will GPs and nurse practitioners (NPs), with special interest and training in ADHD, be able to diagnose/assess ADHD as well as prescribe, or will they still need sign-off from a psychiatrist or psychologist?
A: Yes.
In the case of ADHD, it's not possible to separate diagnosis and treatment, so starting someone on stimulant medicine is, in effect, confirming they have ADHD.
If vocationally registered GPs and nurse practitioners (NPs) working in their area of practice, have a specific interest in ADHD, and develop the necessary competence, being able to start patients on stimulant medicines makes it possible for them to assess, diagnose and treat ADHD. The initiating GP or NP won’t need sign off from a psychiatrist or psychologist to do this, but will need to be comfortable with the assessment made by another health practitioner, or competent in performing the assessment themselves. This is standard practice for prescribing health practitioners.
The Ministry of Health sees three situations where GPs or NPs would initiate ADHD treatment:
After a person has been assessed and diagnosed by another health practitioner (for example a psychologist or overseas clinician). By prescribing stimulant medication the GP/NP is confirming a diagnosis of ADHD.
After they have assessed and diagnosed a person with ADHD themselves. In this case GPs and NPs will be offering ADHD services of assessment, diagnosis, and treatment.
After working with people they have been involved in assessing and diagnosing through a multidisciplinary community of practice or model of care. In this case there may be other health practitioners, such as psychiatrists and psychologists, working as a group to provide assessment, diagnosis and treatment.
Q: How much of a change will this be to what GPs and NPs have previously been able to do?
A: Previously GPs and NPs in primary care were unable to assess, diagnose, or begin treatment for ADHD without recommendation from a psychiatrist or paediatrician. The 1 February prescribing changes will extend their practice scope to include this. Competence in ADHD is required in the same way as it is in all other areas of their practice.
Q: Does this mean people will be able to go to their local GP for an ADHD diagnosis?
A: Even though offering these services will be possible, not all GPs and NPs will choose to. Offering ADHD services is not considered a core part of general practice so those who do will need to develop a specific interest in ADHD.
Q: What do the ‘ADHD services’ mentioned in the Ministry of Health information sheet cover?
A: ‘ADHD services' is an umbrella term covering assessment, diagnosis, treatment, ongoing prescribing, and follow-up. We have used this because services offered will vary depending on the local provider.
Q: How can we be sure the GP or NP providing these services is capable of doing so?
A: The Medical Council of New Zealand | Te Kaunihera Rata o Aotearoa and the Nursing Council of New Zealand | Te Kaunihera Tapuhi o Aotearoa are the authorities responsible for making sure health practitioners are working with competence within their scope of practice.
The ADHD Clinical Principles Framework and other international guidelines for ADHD provide expectations for assessment, treatment and diagnosis. ADHD assessment should be comprehensive, include feedback from multiple sources, and consider other diagnoses with similar symptoms. The full assessment expectations can be found in the New Zealand Clinical Principles Framework for Attention Deficit Hyperactivity Disorder (health.govt.nz)
Note: ADHD New Zealand will be producing a plain language version of this framework to help clinicians and the ADHD community understand what is required for a good assessment.
Admin Login