Six Months On: What I’m Noticing About the Changes to ADHD Care in New Zealand

Back in July 2025 I published a blog post about the then-upcoming changes to diagnosis and treatment for adults with ADHD, and my thoughts on what may happen. In February 2026, the rules around ADHD prescribing changed. Specialist GPs and nurse practitioners (NPs) working within their area of practice became able to initiate stimulant medication for adults with ADHD, rather than this requiring specialist (psychiatrist) approval. The intention was to improve access to ADHD treatment and reduce some of the long waits and costs that had become such a problem around the country, and the Ministry of Health produced a voluntary guideline to assessment and treatment standards.

We are only six months into the new system, so it is too early to draw firm conclusions about how well it is working. I also only see one part of the picture, through my own work assessing adults for ADHD and talking with clients about what happens after their assessment. I wanted to write what I had noticed from my perspective, and compare this to some of my thoughts from the June 2025 blog post.

For Many People, Access to Medication has Improved

In my 2025 post, I predicted that there would probably be more GPs and NPs willing to prescribe ADHD medication than there would be willing to undertake ADHD assessments themselves. From what I am seeing so far, I think that prediction was fairly accurate.

One of the most positive changes I have noticed is that many – perhaps most – of my clients’ GPs have been willing to consider initiating ADHD medication following a comprehensive psychological ADHD assessment. There are some GP practices who advertise that they will perform the assessment themselves, usually for several hundred dollars - still cheaper than a psychiatrist or psychologist.

Previously in Canterbury, even when someone had completed a detailed assessment with a psychologist and clearly met criteria for ADHD, that report had to be referred to the adult mental health service by the person's GP, where it could take up to three months (and sometimes longer) for approval from the public health psychiatrist to start meds to be sent to the GP. For everyone outside of Canterbury, there was no public pathway, so it was harder to get access to medications, and seeing a psychiatrist was required.

For many of my clients, the new process has been considerably more straightforward. They can take their assessment report back to their GP, who can bring their knowledge of the person's physical health and medical history to the medication side of treatment. It is a genuinely collaborative model, and in many cases it avoids the previous need to add another clinician and another lengthy step to the process. Some of my clients have been able to start on meds the same week I email their assessment report to their GP. This is a genuine improvement that I am happy about.

What Happened to My Worry About the “15-Minute ADHD Appointment”?

One of my concerns in 2025 was that the changes might be interpreted as meaning someone could attend a single brief GP appointment, be diagnosed with ADHD and leave with stimulant medication.

There is an important distinction I would make now. I am seeing some clients start medication following a standard 15-minute GP appointment – but only after they have already completed a comprehensive ADHD assessment. I don't see anything inherently problematic about that. If the diagnostic work has already been done thoroughly, a GP does not need to repeat the entire assessment simply because they are the prescriber.

My concern remains about very brief diagnostic assessments. The Ministry's framework requires a comprehensive assessment covering developmental history, impairment, differential diagnosis, concurrent conditions and collateral information, but does not specify how much time this should take. I therefore still wonder how some of the very brief assessment models now being advertised can adequately meet those expectations. I'm sure someone must have been diagnosed in 15 minutes, but so far I haven't heard about it.

Has ADHD Assessment Actually Become More Affordable?

Another question I raised in 2025 was cost. At the time there seemed to be an expectation in some public discussion that moving ADHD care into primary care would make assessment substantially cheaper. I am not sure that this has happened.

There are now more options for accessing assessment and treatment, which is undoubtedly valuable. However, the new GP and NP ADHD services operate as separate, privately funded services rather than as ordinary subsidised GP appointments, including when this assessment is performed within a normal GP practice. Comprehensive assessment still takes clinician time, regardless of which profession provides it, and doctors have a higher hourly rate than psychologists, and there is no public funding for these assessments.

There is also an interesting distinction between the cost of assessment and the cost of medication initiation. For some of my clients, as mentioned above, the latter has become dramatically simpler and cheaper: they complete their assessment with me and then see their usual GP for a standard appointment. For others, their GP practice has introduced a separate ADHD pathway involving multiple appointments and several hundred dollars in additional fees, even when a psychologist has already performed an assessment. For online GP assessments, these again cost several hundred dollars.

So six months in, I think the changes have increased the number of possible pathways to ADHD care, but I am less convinced that they have solved the underlying issue of affordability.

Access to Meds Depends Considerably on Which GP You Happen to Have

Providing ADHD services was always going to be voluntary. The Ministry of Health was explicit from the beginning that not every GP or NP would choose to take this work on, and that services would develop differently around the country. I had concerns that this would create disparity in treatment access, and it has.

When a person's own GP is comfortable initiating ADHD medication, the pathway can work very well. When their GP is not, the person suddenly has another problem to solve.

They may need to find out whether another GP within the same practice is willing to do it. They may consider changing GP or changing medical practice altogether if the practice has a policy that they won't do assessments or start medications. They might pay to see a psychiatrist privately (expensive), or try to locate a GP elsewhere who offers ADHD medication initiation as a separate service.

For someone who has just been diagnosed with a condition characterised by difficulties with planning, organisation, initiation and persistence, this can be a substantial additional hurdle and demoralising. My concern is that some people will simply stop at this point. Others may delay treatment for months while they work out what to do next.

Medication is the best evidence-based treatment for ADHD. It doesn't solve all problems, and it doesn't work well for all people, but the guidelines were supposed to open up this treatment for more people, and for some, they are stuck still trying to access it even after they have paid for an assessment.

A New ADHD Service Landscape is Appearing

Another interesting development is how rapidly new models of care have begun to appear.

There are GPs and NPs establishing stand-alone ADHD services offering assessment, medication initiation or both, many online. From my recent attendance at the Australasian Association of ADHD Professionals (AADPA) conference in Melbourne, I am also aware of networks of GPs using online discussion platforms to support one another with ADHD-related clinical decisions (it would be great to see a larger contingent of NZ clinicians at next year's AADPA conference!).

I think this kind of collegial support is potentially very valuable. ADHD assessment and medication management involve many clinical judgements, and it makes sense that clinicians new to this area would want access to colleagues with greater experience.

At the same time, it raises a question I have been thinking about increasingly: what training and supervision are clinicians actually receiving before beginning and in the early stages of ADHD assessment work?

The Framework Sets a High Standard – But There is no Mandatory ADHD Accreditation

The Ministry of Health's New Zealand Clinical Principles Framework for ADHD is reassuringly clear about what a good ADHD assessment should involve. It states that ADHD assessment and diagnosis should be undertaken by a registered health practitioner with appropriate competence. For adults, this can include GPs, nurse practitioners, psychologists, paediatricians and psychiatrists. It also states that clinicians should have expertise in ADHD diagnostic assessment or undertake assessments under the active supervision of an experienced clinician.

The framework does not stipulate a minimum assessment duration. Instead, it specifies what a comprehensive assessment should include. This leaves considerable variation in how clinicians structure their assessments, and raises the question of how some very brief assessment models can adequately cover developmental history, impairment, collateral information, differential diagnosis and concurrent mental health conditions (I'm always concerned about how well people are being screened for bipolar disorder).

There is no government requirement for a GP or NP to complete a particular ADHD training programme or accreditation before offering these services. Clinicians are expected to develop and maintain appropriate competence under their existing professional obligations, and professional bodies may provide their own education or recommendations. The Government has also not specifically funded ADHD training for new prescribers. That leaves me curious about what is happening in practice, especially if clinicians new to the field are receiving the suggested active supervision from an experienced clinician.

Other jurisdictions have taken a more structured approach to expanding ADHD care in primary practice. In the Australian state of Victoria, GPs authorised to diagnose ADHD and initiate medication must first complete an endorsed training programme, while New South Wales requires accredited training or a formal demonstration of equivalent prior competence.

Some clinicians will have undertaken considerable training and supervision. Some will have been working alongside psychiatrists or other ADHD clinicians for years. Others may be much newer to the field. At present, from outside those professional networks, it is difficult to know.

Psychologists May be an Underused Resource

One thing I find disappointing is that psychologists do not appear to have been widely recognised as a potential source of training and supervision as the new system has developed. This seems like a missed opportunity.

Psychologists are explicitly identified in the Ministry's framework as appropriate professionals to assess and diagnose ADHD when they have the necessary competence. Many New Zealand psychologists have also spent years conducting comprehensive adult ADHD assessments, including developmental histories, differential diagnosis, assessment of comorbid mental health conditions, structured diagnostic interviewing and consideration of functional impairment. Many of us also provide therapy, so understand ADHD well from both diagnosis and treatment angles.

Psychologists obviously cannot provide training in prescribing medication. That requires medical expertise. But assessment is a different skill set.

As GPs and NPs begin learning how to assess ADHD, it would make sense to draw on clinicians who already have considerable experience doing exactly that work. Ideally, I would like to see more interdisciplinary ADHD training: psychologists contributing expertise in assessment and differential diagnosis, alongside psychiatrists and experienced medical prescribers contributing expertise in medication and medical risk. Psychologists also have a lower pay rate than psychiatrists, so surely this also makes financial sense.

There is Also a Concerning Growth in Unregulated Online Screening and "Assessment"

At the same time that access through primary care is expanding, I have noticed increasing numbers of online services offering ADHD “screening”, and sometimes what appears to be ADHD assessment, without the person providing it being a registered health practitioner.

Screening itself can be useful. There are freely available questionnaires that can help someone decide whether it might be worth seeking a proper assessment, and I point people to these myself at times. But screening is not assessment and should not lead on its own to diagnosis.

The Ministry framework states specifically that ADHD diagnosis should be undertaken by a registered health practitioner with the requisite competence.

I have raised concerns about one of these advertised services offering assessment and diagnosis with a non-registered person with the Ministry of Health. The response I received stated that the Ministry didn't think the evidence (a non health practitioner advertising themself as capable of assessing and diagnosing ADHD) as sufficient evidence meeting the "criminal standard of proof" to do anything about it. I was frustrated and dismayed at this response. It appears that the Ministry has no intention of enforcing one of the easier requirements within their own framework (kind of makes me wonder why I bother maintaining registration as a psychologist if I could do the same work unregistered...).

I suspect this is an area that will need further attention from the Ministry as demand for ADHD assessment continues to grow and more insufficiently qualified people may advertise assessment and diagnostic services, believing that simply getting a GP or NP's seal of approval is enough to bypass the requirements of the ADHD framework.

Canterbury May Actually Have Lost Something

Nationally, I suspect the February changes will ultimately improve access. More clinicians can prescribe, new services are developing, and some people who previously faced very long waits can now receive treatment through primary care. Canterbury, however, is an interesting exception.

Before the national changes, Canterbury had a public pathway through which adults who had received a comprehensive ADHD assessment could be permitted to begin ADHD medication by a public health psychiatrist, with ongoing prescribing often then managed by their GP, with input from the public health psychiatrist. Disappointingly, that pathway ended in November 2025, leaving a three month gap before the new prescribing rules even began.

The new national model theoretically gives GPs greater independence, but in practice there are GPs who do not feel comfortable taking responsibility for ADHD medication without the specialist psychiatric support that was previously available.

So while the national change was intended to improve access, my impression is that some adults in Canterbury may currently have less access to medication than they did under the previous local system.

That may change as more GPs gain experience and confidence. But it illustrates something important about health-system reform: increasing the number of professionals legally able to provide a service does not automatically mean that every patient will find that service easier to obtain. It's obvious that this would happen, but of course it wasn't included in the official narrative about the changes, which of course was all positive.

A System That is Still Finding its Feet

Overall, I remain cautiously optimistic about the changes. I am seeing people access medication through their GP or NP who previously would have faced another expensive appointment or a lengthy wait. I am seeing clinicians developing new services and supporting one another to build ADHD expertise. These are encouraging developments. At the same time, the new system is uneven.

Access can depend heavily on an individual GP's confidence and willingness to provide ADHD care. Training and supervision appear to vary and there is no government-endorsed training or funding provided to upskill. Psychologists with established ADHD assessment expertise seem to be an underutilised training and supervision resource. And local changes mean that improvements nationally do not necessarily translate into improvements in every region.

I think the next stage needs to involve more than simply asking whether more clinicians can diagnose and prescribe for ADHD. We also need to ask whether clinicians are adequately supported to develop competence, whether they are accessing appropriate supervision in the early stages of their assessment practice, whether people can access similarly high-quality care regardless of where they live or who their GP happens to be, and whether the different professional groups working with ADHD are making the best use of each other's expertise.

Six months in, the picture seems promising but still very much a work in progress.