The problem has been dubbed a nationwide crisis, and GPs are calling for more support to improve outcomes for families.
“We are going through a very difficult time when many families do not have access to a pediatrician for support in treating and diagnosing developmental disabilities.”
This is Perth GP Dr. Andrew Leech, who has a special interest in pediatrics and expresses concern about it NewsGP.
The situation has deteriorated to such an extent that Dr. Leech wrote this week to Western Australia’s (WA) new Minister of Health, Amber-Jade Sanderson, telling her that GPs are ‘reaching a tipping point, a crisis linked to the prolonged waiting times and the closure of paediatrician books, especially developing paediatricians’ .
But WA isn’t the only jurisdiction plagued by problems accessing paediatricians, as an unprecedented rise in mental health problems among children and young people has led to more families across Australia seeking support and many being turned away.
Sydney-based GP and Chair of the RACGP Special Interests Child and Young Person’s Health, Dr. James Best, narrated NewsGP the issue is of national importance.
“The lack of access to diagnosis and even prescription of stimulants — which primary care physicians are generally unable to do, not even repeat scripts — for children who already have an ADHD diagnosis is at a critical juncture,” he said .
“Paediatricians and psychiatrists just can’t handle the numbers.”
A WA psychiatrist who sees teenagers from 15 to adulthood narrated NewsGP that although he does not work in paediatrics, the waiting list for his clients is “also very long” and it is “very difficult” to get to a psychiatrist.
dr Best has heard similar messages from multiple jurisdictions, not just New South Wales.
“I’ve had many conversations with paediatricians, university researchers in this field and many family doctors specializing in paediatrics who all say the same thing: something has to be done,” he said.
dr Leech’s letter highlights “untold stories” of families who are “desperate” to get the help they need for their child.
“Yesterday, for the first time, I was unsuccessful having a pediatrician take care of a patient for evaluation and diagnosis of a neurodevelopmental disorder,” he wrote.
“This is after a series of 10 separate recommendations and phone calls. This is with my request as a healthcare professional and with my background knowledge that the child needed help.
“I’ve heard stories of parents queuing at a pediatrician’s office at 5am when they heard they were offering more appointments.
“I’ve made parents cry in my office because they don’t know where to turn after 30, yes 30 phone calls, including the freeway.”
According to the WA State Child and Adolescent Health Service, referrals to the state Child Development Service (CDS) — which provides free, state-funded assessment, early intervention and therapy services for children — increased 41% in 2021 compared to 2016.
“Remittances to CDS have increased over the long term, particularly over the past five years, leading to longer wait times for services,” the spokesman said NewsGP.
“CDS has a strong culture of service improvement and is actively working with the systems manager to meet growing demand.
“Last year, the Child and Adolescent Health Service funded additional temporary CDS pediatrician positions internally, as well as pediatric training positions.”
However, with families now in need of help, Dr. Leech “urgently” proposes a range of solutions to enable GPs to be better supported through their coordinated care role with paediatricians.
These include early intervention and education models, as outlined in his letter, and reform of current prescribing practices.
“The sooner these families are supported with a thorough assessment and treatment plan, the greater the chance they will avoid … negative consequences [and] the better off this whole family will be,” he writes.
“In addition, the entire health and education system will do better.”
dr Leech highlighted the need for a patient to see a specialist pediatrician before being prescribed a stimulant as the “leading” cause of delays in treatment of pediatric developmental disorders.
“I suggest that a legal means of allowing this to happen is sought as soon as possible [with verbal authority of a paediatrician] the prescription of certain stimulants by specially authorized general practitioners,” he wrote.
“To ensure this process, I also propose the formation of a Pediatric General Practice Council in WA, which includes at least one pediatrician and/or child psychiatrist.
“Such a council would be responsible for developing training for GPs to better diagnose and treat pediatric developmental disorders in primary care.
“The training would be accredited and reviewed annually by paediatricians, but need not be too cumbersome as this group of GPs most likely already has the skills and knowledge to recognize at least most of these issues already.”
dr Best has long called for the important role of primary care physicians in early intervention and treatment, including referral pathways, to be recognized and supported by integrated models of care.
The implementation of Australia’s first national strategy for child mental health and well-being, launched late last year, is helping Dr. Best, who was involved in the development, helped create this framework.
‘That [strategy] The report got it right and acknowledged the critical role of primary care, particularly general practice, in this area,” said Dr. best before NewsGP.
“The emphasis on looking at the child in a family or community context is very sensible and also goes with the principles of general medicine.”
dr Leech concludes his letter to the WA Secretary of Health by calling for change to put children and their families on the right track for a prosperous future.
“I’m doing this because I truly believe that we can make a difference in so many situations [and] with so many young lives,” he wrote.
“With the right steps and processes, I believe this will set the standards for pediatric care going forward.”
Neither the Department of Pediatrics and Child Health of the Royal Australasian College of Physicians nor the Neurodevelopmental Behavioral Pediatric Society of Australia and New Zealand could comment before publication.
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