GPs can now prescribe ADHD medication – but big barriers to treatment remain

For years, adults seeking treatment for attention deficit hyperactivity disorder (ADHD) in New Zealand have faced a frustrating bottleneck.

Public mental health services have had little capacity to assess adults, while seeing a psychiatrist privately can cost hundreds or even thousands of dollars.

For many people, particularly those outside the main centres, getting diagnosed and treated has proven difficult or simply unaffordable.

That changed in February. Vocationally trained GPs and nurse practitioners can now start adults on stimulant medication, ending a system that had largely left this to psychiatrists and paediatricians.

The reform was intended to make treatment easier to access.

But nearly eight months on, changing who can prescribe has exposed another problem: having more potential prescribers does not necessarily mean people can get assessed or treated.

Opening the door to treatment

ADHD is estimated to affect between 2.5% and 3.4% of adults. Left untreated, it is associated with poorer educational and employment outcomes, mental health problems, substance use and involvement with the justice system.

Stimulant medication is recommended as a first-line treatment in international guidelines and can substantially improve outcomes for people with ADHD.

Yet New Zealand has had a sizeable treatment gap. When I analysed national prescribing data from 2022, I found only about one in three adults under 50 with suspected ADHD received stimulant medication.

Access was also uneven. Those able to pay for private assessment had a much clearer route to treatment, while Māori, Pacific peoples and people facing financial hardship were more likely to miss out.

Just how much is the new system likely to improve things? One immediate issue is that it leaves considerable discretion over how ADHD is assessed in primary care.

A national clinical principles framework, released in 2025 by the Ministry of Health, Pharmac and the Royal New Zealand College of General Practitioners, says clinicians should have “expertise” in ADHD assessment. But there is no required training or competency standard.

It also refers to “validated diagnostic tools” without specifying which ones should be used. Many GPs are understood not to be prescribing through an ADHD care pathway yet, leaving patients without a clear route to treatment.

ADHD itself can also be difficult to diagnose. A thorough assessment can take one to three hours, far longer than a standard GP appointment.

More than 60% of adults with ADHD have another condition, such as anxiety, depression, post-traumatic stress disorder (PTSD) or autism, which can complicate diagnosis. Complex PTSD, for example, can resemble ADHD or occur alongside it, while stimulant medication may worsen some symptoms associated with trauma.

A rushed assessment therefore risks both missed diagnoses and inappropriate prescribing. Doctors and nurses raised these concerns when Medsafe and Pharmac consulted on the changes.

Cost remains another barrier. General practice is already stretched, GP visits are not free, and an assessment lasting several hours may still be beyond what many people can afford.

This risks replacing one barrier with another. Access may depend on which practice someone attends and what they can afford, rather than their need for treatment.

That is particularly concerning for Māori, Pacific peoples, rural communities, people on low incomes, rainbow communities and others who already face barriers to ADHD care.

What should happen next?

Several new models of ADHD care are already emerging within the health system.

Some GPs may handle assessment and treatment themselves. Elsewhere, mental health nurses, psychologists or occupational therapists can carry out much of the assessment, with a GP or nurse practitioner managing medication.

Primary health organisations can also provide dedicated assessment services across multiple practices. Commercial ADHD clinics, including telehealth services, are expanding too, although concerns have been raised about regulation and the risk of over-diagnosis.

Without greater consistency, however, the quality, cost and availability of care could vary considerably between providers.

Medication is only one part of ADHD care. International evidence shows people with ADHD can benefit from psychoeducation – understanding the condition and learning practical ways to manage it, including routines, planning and sleep.

Without this support, some patients may receive a prescription and little else.

A better system would have a clear national pathway designed for Aotearoa New Zealand, shaped by people with lived experience and their whānau, and grounded in Te Tiriti o Waitangi.

It would set competency standards, specify appropriate assessment tools and establish when complex cases should be referred for specialist care. It would also fund the team-based approach that good assessment can require, so a person’s ability to pay does not determine the care they receive.

The February changes also need to be evaluated.

Our team are now analysing national dispensing data to see whether adult prescribing has increased since the reforms, and whether those previously most disadvantaged are benefiting.

Further, we need to understand how the new system is working for patients and clinicians.

This year’s prescribing change removed a significant barrier to ADHD treatment. But it was only the first step. Whether it ultimately reduces inequities in ADHD care will depend on the system built around it.

This analysis draws on a recent New Zealand Medical Journal article co-authored with Lara Oertly, Belinda Wheaton, Byron Rangiwai, Nicholas Bowden and Stephanie D'Souza.