H2025076445 response bundle Part4.pdf

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Will every GP and NP offer ADHD care and/or stimulant treatment
on 1 February?
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Reality
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•  GPs and NPs with a special interest in ADHD, and who have developed
confidence and competence in ADHD wil  offer ADHD services. What is offered wil
vary according to a prescribers' competence and confidence.
• Services wil  develop gradually and vary by location and region.
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• Local service models wil  develop, and what emerges in a local area depends on
factors such as the clinicians in that area and local funding arrangements.
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Key messages
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• Not al  GPs or NPs wil  provide ADHD assessment and start ADHD stimulant
treatments. The change opens up options if they choose to do the work.
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• Talk to your GP or primary care provider about what they are offering and what
might be available local y.
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How will clinical quality and safety be maintained?
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• The government has not mandated any specific training in ADHD as part of this policy,
but there is an expectation that prescribers develop the necessary competence
to deliver ADHD care.
• Expected standards for ADHD care in the NZ context are described in the Ministry of
Health's NZ Clinical Principles Framework for ADHD
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• Clinicians should also follow evidence-based guidelines (e.g. AADPA, NICE guidelines).
• Professional bodies are developing training and/or expectations for their members.
• Registered health professionals are regulated und
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er the HPCA (2003).
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Key messages for communities
• If you’re worried about quality, talk to your provider first.
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• There are no changes to the ways in which concerns can be raised. Consumers have
rights and providers have obligations under the Code of Health and Disability
Consumers' Rights.
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What are the be standards and expectations for ADHD care?
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• There are expected standards for ADHD care in New Zealand.
• These are set out in the NZ Clinical Principles Framework for ADHD,
published by the Ministry of Health in July 2025.
• Based on evidence and adapted for NZ.
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• Covers assessment, diagnosis, and treatment for al ages.
• Developed by clinicians and people with lived experience.
• It sets out that competence is not just a qualification; competence
includes clinical expertise and experience
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• Competencies include comprehensive as
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rating scales, diagnosing according to DSM/ICD criteria, and
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• Care should include both medication and non-medication options.
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Will ADHD assessments be done in a 15-minute appointment?
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• ADHD assessment is comprehensive and usual y takes 60–120 minutes or more,
sometimes over multiple visits.
• Quality care fol ows the NZ Clinical Principles Framework for ADHD.
INFORMATION
Key messages:
• A good ADHD assessment takes time and inc
OFFICIAL ludes history, questionnaires, and
checking for other conditions.
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• If someone offers a quick assessment, ask what’s included and whether it meets
the expected standards.
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Will ADHD care be free or very low cost?
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• ADHD services are not included in core general practice funding (capitation) and can
beconsidered specialist care, delivered in the community.
• Costs for ADHD services under this new policy wil vary according to several factors: the
providers, any local funding arrangements, and the type of service being offered.
• Fees reflect the specialist time and expertise needed for quality assessment and treatment.
INFORMATION
• Ongoing prescriptions are usual y part of standard GP visits (core funding).
Key messages:
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• The cost for ADHD assessment and starting treatment wil not be the same as a standard GP
appointment.
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• The cost is expected to be similar to the cost of private psychiatrist assessments.
• Providers set fees based on the time and expertise needed for a quality assessment and
treatment plan.
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• Always ask about fees before booking an assessment or treatment.
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Will this make it easier for people who need it the most?
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Reality
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• We are aware that fees for ADHD care and their availability wil  vary.
• Private assessment costs can be a barrier for adults.
• Cultural y safe care and responsiveness are essential to providing high quality care.
• The Ministry of Health wil  be monitoring the impact of these changes to inform future
policy and planning.
INFORMATION
Key messages for communities
• Share feedback about gaps and barriers so we c
OFFICIAL  an improve.
• Ask providers about low cost or funded options where available.
• Ask providers for cultural y safe support f
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communities.
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ADHD Medicine supply challeng
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• ADHD stimulant medicines (especially methylphenidate) have had
global supply issues since 2023.
• These shortages are expected to continue because demand is high
and manufacturing is limited.
INFORMATION
• Stimulant medicines are control ed drugs, so there are extra safety
rules (e.g., 3-month prescriptions, monthly dispensing, caution when
switching brands).
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• Methylphenidate is especially c
THE omplex because different brands
have different release profiles.
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We know not being able to get the medicine that works for you is
stressful. We’re working to make supply more resilient and support
safe switching when needed.
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Models of GP/Nurse Practitioner provision of ADHD assessment
and management
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A number of models already exist, and other groups are looking to emulate these:
1. GPs with Special Interest (GPwSIs) in Mental Health and
Addiction and Mental Health NPs – providing “psychiatry”
services (including assessment and manag
INFORMATION ement of ADHD) in a
primary care setting, supported and supervised by a
psychiatrist (eg, Tamaki Health);
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2. GPs trained in ADHD assessment and management, working in
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a specialised ADHD clinic, supported and supervised by a
psychiatrist (eg, Beehyve);
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3. Mental Health NPs working as part of a private
psychiatry/psychology clinic, undertaking ADHD assessments,
supported and supervised by a psychiatrist
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Will GPs providing ADHD assessment and management need to
complete training?
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• The NZ Clinical Principles Framework clearly sets out the expected standards for
assessment and management of ADHD.
• These standards also establish clearly what training is required to develop the clinical
expertise to assess and manage ADHD.
INFORMATION
• The Col ege of GPs have developed a training programme – a series of weekly online
teaching modules delivered by a psychiatrist - that is currently being delivered for the
first time.
OFFICIAL
• The Goodfel ow Unit are also developing a series online learning modules which wil be
ready for release by early 2026, and inclu
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with content presenting a lived experience perspective.
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What support structures are needed to support GPs undertaking
this work?
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• The Col ege of GPs are currently working to develop clear professional standards for GPs
undertaking this work. These standards are likely to include an expectation of access to
specialist consultation and support.
• There have been pre-existing groups of GPs with an interest in ADHD – more of these
groups are forming.
INFORMATION
• These groups are already looking to engage support from a psychiatrist (or already
have) for phone/email consultation when needed, and to join their group peer review
sessions.
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Ka whakairia te tapu
Kia wātea ai te a
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Kia tūruki whakataha ai
Karakia
Kia tūruki whakataha ai
whakakapi
Haumi ē, hui
INFORMATION ē, tāiki ē!
Closing karakia
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THE Restrictions are moved aside
So that the pathway is clear
So we may move forward
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Join, group, and affirm
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6.2.4 Neurodiversity – upcoming regulatory prescribing changes to ADHD
stimulant medications
This item updates you on the upcoming regulatory prescribing changes to enable general
practitioners and nurse practitioners to initiate stimulant treatment for adult patients with
ADHD.
Context
On Friday 3 May 2024, the ADHD parliamentary hui agreed to expand the clinical workforces
who can initiate prescribing of ADHD stimulant medications to include general practitioners
(GPs) and nurse practitioners (NPs). The proposed changes will allow vocationally registered
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GPs and NPs to initiate prescribing of ADHD stimulant medications for adults. For children
and adolescents with ADHD, diagnosis, and initiation of prescribing of stimulant treatments
will still require paediatricians and psychiatrists working within specialist services but will
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expand to include NPs working within these settings.
Pharmac and Medsafe ran the public consultation on the regulatory prescribing changes to
the Misuse of Drugs Act 1975 regulations, which took place from December 2024 to
February 2025. There was overall support for expanding prescribing permissions to GPs and
NPs.
Medsafe will be accepting the proposed changes in the next week, and once confirmed, we
expect the changes to come into effect in July 2025.   INFORMATION
Comment
Prescriber changes
Prescribing changes will enable more adults to receive stimulant medications for ADHD
within primary care settings. In anticipation of the proposed prescribing changes, the
OFFICIAL
Ministry has jointly developed an ADHD clinical principles framework with the clinical
colleges and professional bodies. It contains information for health professionals and the
public on the standards they should exp
THE ect regarding assessment, diagnosis, and treatment
for ADHD in New Zealand. The framework provides an additional layer to support quality of
clinical care for ADHD.
While the changes will improve access to medication for adults, there will be minimal
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impacts for children and adolescents. Children and adolescents will still require involvement
from specialist services, but the changes will enable NPs working in specialist services to also
initiate treatment for paediatric ADHD.
The diagnostic pathway for ADHD is not changing
Officials anticipate that there may be high public expectations that with the changes to
prescribers, primary care will be able to assess and diagnose adults with ADHD because of
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these changes. This will not be the case and there will need to be careful communication on
the prescriber changes as a result.
The prescriber changes in primary care do not provide any additional funding for the
significant clinical time it would take to enable GPs and NPs who do not already do so to
assess and diagnose ADHD. Assessment and diagnosis of ADHD for the adult population is
not publicly funded and currently patients bear these costs.

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Currently, there are primary care teams across New Zealand who have access to
appropriately trained clinical workforces and could take the time required to assess and
diagnose an adult with ADHD. However, this is not the case for all areas of New Zealand. We
do not anticipate that the changes will increase the ability for adults to access publicly
funded ADHD assessment and diagnosis in primary care. Achieving this would require either
a new funding stream, or redirection of existing funding through disinvestment of other
activities of primary care.
It is important to note that without new funding to primary care teams for the assessment
and diagnosis of ADHD, such assessments will continue to be provided privately and access
will continue to be limited and variable across New Zealand.
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Additionally, Pharmac has advised that the supply issues for ADHD stimulant medications
will continue throughout 2025. Pharmac expects supply issues to ease in 2026 and will
continue to provide updates to yourself and Ministers Seymour and Willis (as Social
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Investment Minister).
Next steps
Officials will continue to engage with Health NZ regarding the changes to prescribing of
stimulant medication. Both agencies will also discuss how to communicate the prescribing
changes to the health workforce, highlight the potential pathways for assessment of ADHD,
the availability of workforce training, and managing clinical safety for patients.
INFORMATION
To address some of these action areas and to ensure the workforce and the public are aware
of the upcoming prescribing changes, officials are:
•
working with Medsafe, Pharmac, and Health NZ to develop clear communications for
the public on the upcoming prescribing changes for stimulant medications and what
they can expect from the changes
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•
planning to publish the ADHD clinical principles framework alongside information on
the upcoming prescribing changes for stimulant medications in the coming months.
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Deputy Director-General  Geoff Short, Clinical, Community and Mental Health, s 9(2)(a)

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NZ ADHD Consensus document: Project Charter
Purpose
This Project Charter outlines an overview of the project to develop a NZ ADHD Consensus
document and initial thoughts on the scope, processes, and considerations.
The NZ ADHD Consensus document will be a guiding document based on best practice and
not a mandatory directive. It will provide a joint understanding and agreement on
identification, diagnosis, treatment, and management of ADHD across the life course. The
document will clarify:
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• the roles and responsibilities of the clinical workforce involved in supporting ADHD,
and
• the expectations of services and supports available for people with ADHD and their
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whānau.
Outcomes
Developing a NZ ADHD Consensus document will help contribute to the following goals:
• Nationally consistent diagnosis and treatment of ADHD as appropriate for child, youth
and adult age groups.
• Reduced variation of health outcomes through improved access to ADHD support for
INFORMATION
groups currently disadvantaged.
Deliverables
A final draft NZ ADHD Consensus document will be delivered by mid-December 2024 and
will be shared with the Hon Matt Doocey, Associate Minister of Health. A final agreed version
will be published on the Ministry of Health website in early 2025.
OFFICIAL
Three to four fortnightly meetings from mid-October 2024 will be organised to support the
development of the document. THE
Context
Improving access to support for ADHD in New Zealand has seen a rising increase in public
and political interest. Health agencies and professional groups involved in the diagnosis and
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treatment of ADHD have agreed on actions to improve support for people with ADHD, and
many of these are progressing.
There is limited data available on the level of unmet need for ADHD treatment. Prevalence
data from the New Zealand Health Survey shows that children and young people aged 5 to
14 years diagnosed with ADHD fluctuates between 2.8% and 3.9% over the past five years,
and this may under-represent the true level of need. Australian epidemiological data
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collected in 2013/14 suggested a 12-month ADHD prevalence of 7.4% in children and young
people aged 4 to 17 years. Additionally, a 2021 meta-analysis of international
epidemiological studies suggests that persistent ADHD affects between 4% and 5% of the
adult population worldwide.
We are experiencing challenges with timely assessment and diagnosis of ADHD due to
capacity constraints within infant, child, and adolescent mental health services who prioritise
young people and families with the highest mental health needs. Pressures on services are
driven by increased presentations for ADHD diagnosis and treatment, which is similar to

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trends being seen internationally. Health services are also experiencing workforce shortages
across key professional groups including child and adolescent psychiatrists.
Access to ADHD stimulant medications can be an important and effective part of ADHD
treatment. There are three main issues regarding access to funded ADHD stimulant
medications. These are:
•  the type of health professionals that can initiate prescribing,
•  the requirement to renew Special Authority approval from Pharmac for these
medications every two years, and
•   supply challenges due to ongoing global supply constraints for some ADHD
medications, in particular methylphenidate.
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Pharmac and Medsafe are working on actions to address some of the issues relating to
medications.
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We are aware of the current variation in services and clinical practice for diagnosis and
treatment including different models of care and patient costs.
Resources
•  ADHD project team – governed by the ADHD Programme Oversight group.
•  Secretariat support from the Ministry of Health, however, open to professional
colleges/bodies who may be interested in providing support.
•  Clinical Reference Group made up of key stakeholders including:
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o  Professional colleges/groups
o  Pharmac
o  Lived and whānau experience
o  Health New Zealand clinical representation
o  HealthPathways (Health New Zealand).
•  It is not usual for the Ministry of Health to pay representatives from the publicly funded
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sector for meeting attendance. Lived and whānau experience members will be
reimbursed as per the Cabinet Office Circular Revised Fees Framework. Ministry of
Health may remunerate other parties by mutual agreement.
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Related Activities and Dependencies
Work to develop the Consensus document will need to consider the broader work underway
to improve support for people with ADHD. There are likely to be changes to clinical
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workforce roles and responsibilities in the diagnosis and treatment for ADHD as actions
progress particularly relating to ADHD stimulant medications.
ADHD stimulant medications: From 12 September 2024, Pharmac is publicly consulting
on removing the requirement for a special authority renewal every two years, as well as on
funding a new ADHD medication, lisdexamfetamine, which will help increase the available
supply of ADHD medications. Following consultation, if the proposal is approved by the
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Pharmac Board, lisdexamfetamine will be available in early December 2024.
Pharmac and Medsafe plan to work together to publicly consult on changing the
requirements for who can initiate prescribing of funded and unfunded stimulant medications.
Prevalence of ADHD: The Ministry of Health is testing the tools needed to survey
prevalence of mental health, addiction and substance use for children and young people.
Understanding ADHD prevalence will help define the level of unmet need for support for
ADHD in New Zealand.

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Wider checking of the Consensus document by the Clinical
November 2024
Reference Group with relevant networks/members
Potential consultation with Health New Zealand/Pharmac
December 2024
Finalise draft Consensus document provided to Programme
Mid-December 2024
Oversight Group and Ministers
Consensus adopted by the Ministry of Health, Health New
Early 2025
Zealand, and professional colleges/groups
Publish final Consensus document on the Ministry of Health
Early 2025
website

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Reactive Q&As: New Zealand Clinical Principles Framework for Attention
Deficit Hyperactivity Disorder (ADHD)
Key messages:
• The Ministry of Health has worked with the health sector to develop a clinical framework for
treating Attention Deficit Hyperactivity Disorder (ADHD) in New Zealand.
• The framework is supported by the key health workforces involved in treating ADHD
including paediatricians, psychiatrists, psychologists, nurse practitioners, general
practitioners, as well as people with lived experience of ADHD.
• The framework contains information for health professionals and the public on the standards
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they should expect for evidence-informed assessment, diagnosis, and treatment for ADHD.
• I welcome this move which provides health professionals with a useful and quality resource,
and which adds an extra layer of protection to ensure quality care for patients. ACT
Q&As:
Is the framework a new clinical guideline that professionals must abide by?
The framework is not a new clinical guideline, as there are existing clinical guidelines including the
Australian Evidence-Based Clinical Practice ADHD Guideline that are already being used in New
Zealand and endorsed by the NZ and Australian medical colleges. The aim of the framework is to
bring together these existing evidence-based guidelines and outline how these can be used within
INFORMATION
the New Zealand context and what the public can expect regarding ADHD assessment and treatment.
Why aren’t we creating mandated training requirements for health professionals? How will I know
the GP or nurse practitioner treating me is qualified in ADHD?
OFFICIAL
Most conditions which GPs and nurse practitioners treat do not have mandated training
requirements specific to those conditions. Health professionals are expected to work within their
scope of practice and refer patients to other professionals as appropriate. There are existing
THE
mechanisms to ensure they do this. This includes the Health Practitioners Competence Assurance Act
2003 which requires all GPs and nurse practitioners to be registered with a professional health
workforce body. These health workforce bodies regulate health professionals, providing oversight to
ensure they work within their scope of practice.
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The Ministry of Health is working closely with Health New Zealand and the professional workforce
bodies to make sure there are adequate training opportunities for GPs and nurse practitioners to
upskill in ADHD if they wish to do so.
Some people disagree with some of the expectations in the framework. What do you say to that
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and will the Ministry of Health change them?
The framework was developed with key representatives from professional health workforce bodies
who have a role in assessing and treating ADHD in New Zealand. The aim of developing the
framework was to create consensus amongst the health workforces on the expected standards that
they should refer to when undertaking assessment, diagnosis and treatment of ADHD. The
workforces agreed that having a set of standards to ensure high quality care for patients is essential.

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There may be health professionals who feel they do not have the necessary experience, skills, or
time to undertake the comprehensive process for assessing ADHD, and this may be particularly
relevant to people working in primary care. Therefore, they may disagree that they can appropriately
assess and treat ADHD. The Ministry of Health is clear that the framework is not setting mandated
requirements on health workforces, and a priority is on making sure there is appropriate training
available for the appropriate workforces who wish to upskill and have a greater role in assessing and
treating ADHD in New Zealand.

Will all GPs and nurse practitioners be able to provide support for ADHD?

ADHD assessment and diagnosis is not currently part of the capitation funding provided to primary
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care. If ADHD assessment is offered by general practitioners or nurse practitioners working in general
practice, then this is an additional specialist service and as such will not be provided by every GP or
nurse practitioner. It will involve longer assessments than standard general practice assessments
ACT   and
will attract a cost/charge that reflects this.

Why hasn’t any additional funding been made available for GPs and nurse practitioners to carry
out this work?
As the framework provides a set of expected standards and is not mandating requirements for GPs
and nurse practitioners to assess and treat ADHD in primary care, there are no funding implications
currently to implement the framework.
INFORMATION
I am aware of some of the barriers for access, including sometimes waiting months to access a first
specialist appointment with a specialist to receive an ADHD diagnosis. In addition, I know that for
adults, assessment and diagnosis of ADHD is not currently publicly funded and the costs are borne by
the individual who may have to go to a private provider.
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Increasing access and reducing wait times is one of my priorities for mental health care. The
framework will help enable those GPs and nurse practitioners who have a special interest in ADHD to
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play a greater role in ADHD assessment and treatment if they wish to, and over time this is likely
increase access to support for ADHD.
There is future work to be done in this area too. The Ministry of Health is currently talking to primary
care teams across New Zealand to understand potential approaches for incorporating specialist
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IN CONFIDENCE
Out of scope
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6.2.4 Supply of stimulant medicines for the treatment of ADHD
OFFICIAL
This item updates you on the continuity of supply for the stimulant medicines used for the
treatment of attention deficit hyperactivity disorder (ADHD) [H2025070004 refers].
Context
THE
Medsafe has made changes to the regulatory restrictions that determine who can prescribe the
stimulant medicines methylphenidate, dexamfetamine, and lisdexamfetamine for the treatment of
ADHD. These changes were gazetted on Tuesday 24 June 2025 with the changes taking effect
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from Sunday 1 February 2026 [Gazette notice 2025-go3319 refers]. The changes expand
prescribing authority.
Since mid-2023, there have been ongoing shortages of various brands of extended-release
methylphenidate. These shortages have put pressure on other supplies of methylphenidate causing
further supply issues. Since early 2024, Pharmac has been working on securing additional supplies
of methylphenidate hydrochloride. It expects supply issues to continue to at least the end of 2025.
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Comment
Pharmac is pursuing two strategies to ensure sufficient supply of methylphenidate prior to the start
of February 2026. Firstly, it is working with two existing suppliers and talking to them about
increasing the stock available in New Zealand ahead of February 2026 to meet anticipated increased
demand. Secondly, Pharmac is in negotiation with two new suppliers to increase the options
available. Those negotiations are progressing wel .
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The Ministry has asked Pharmac to develop a timeline with milestones so that progress of these
potential supply issue solutions can be monitored.
Next steps
The Ministry wil continue to work with Pharmac to provide you with regular updates.
Ministry lead
Geoff Short, Acting Deputy Director-General, Strategy and Policy,
s 9(2)(a)
Out of scope
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