By Dr Jaspreet Saini. Published . Updated .
Last reviewed 2026-10-18
For most of the past two decades, adult ADHD care in Australia followed a fixed route. A psychiatrist or paediatrician made the diagnosis and set the treatment, and a GP, if permitted, continued it. People living with ADHD often spent long periods waiting at the first step, and longer still navigating the space between the two.
That route has changed. NSW GPs who complete the state's endorsement training can now assess and diagnose ADHD, start psychostimulant treatment and alter it over time. The change moves the centre of gravity for straightforward ADHD care into general practice, where most lifelong conditions are already managed.
GPs who are not endorsed may still be able to provide a diagnostic assessment for ADHD. However, they cannot initiate ADHD medication. To continue medication started by a specialist, they must be ADHD Continuation Prescribers.
What GP-led care actually involves
Under the NSW model, an endorsed GP can carry the whole arc of care for many people: a structured assessment, a diagnosis where it is warranted, a treatment plan, and the years of review that follow. The GP is not simply renewing a specialist's decision but making clinical decisions in their own right, within a defined scope and with training behind them.
Psychiatry remains central, but in a different role. Complex presentations, diagnostic uncertainty, significant co-occurring mental health conditions and poor response to treatment are all reasons to involve a psychiatrist. The value of the model depends on that partnership being easy to use, with clear thresholds for referral and good communication in both directions.
Why the design choices matter
Two design choices determine whether this works at scale. The first is training and governance: GPs need a clear sense of where their scope ends and a reliable route to specialist advice when it does. The second is clarity for the person receiving care. People should know what their GP is responsible for, what will be monitored, and what would prompt a specialist review.
Continuity is the third, quieter requirement. Much of the case for GP-led care rests on the GP knowing the person over years. A service that rotates people between doctors would lose most of that advantage, however well it was otherwise designed.
Why now
Several things have converged. Demand for assessment has grown well beyond what specialist services alone could meet. General practice already has the infrastructure for long-term care, including recall systems, chronic condition planning and established relationships with pharmacies. And NSW has chosen to pair expanded scope with structured training, which is the combination most likely to hold up over time.
What it means for general practice
ADHD care is longitudinal, relational and closely connected to the rest of a person's health. Those are the characteristics general practice was built around. If the NSW reforms succeed, they will offer a working example of what happens when GPs are given time, continuity and scope together, and that example will be relevant to many other conditions.
Continuity is what general practice was designed to deliver.
Sources
This article is general information, not personal medical advice. Speak with your own doctor about your situation.