April 15, 2026

Pharmac changed the rules for ADHD without funding the doctors to use them

Crutches resting against a wall in a minimalist waiting room with blue chairs.

The formula is familiar in New Zealand health reform. A minister announces a structural fix. The press release lands well. Then the workforce that is supposed to deliver the change discovers nobody attached any money to it.

On 1 February 2026, GPs and nurse practitioners gained the authority to diagnose and prescribe stimulant medicines for adult ADHD without specialist sign-off. Mental Health Minister Matt Doocey called it a “common-sense change.” Two months on, only 15-20% of GPs are actually offering the service. The reason is not complicated. No funding was allocated for training, assessment time, or service delivery.

Pharmac saw this coming and signed off anyway

The most damning detail is not the low uptake. It is that the regulator predicted it. Pharmac’s own June 2025 decision document warned that “it is not clear how primary care clinicians are going to be paid for their time undertaking ADHD assessments” and flagged that the change “could negatively impact an already overstretched primary care system if inadequately resourced.” The document also acknowledged that GPs and nurse practitioners have “limited or no funded access to continuing medical education” and therefore cannot maintain professional standards in diagnosis.

Pharmac identified the implementation risks, wrote them down, and the government proceeded without resolving a single one. There are no accreditation requirements and no additional government funding for training. GPs are expected to upskill on their own time and their own dime.

A 90-minute job crammed into a 15-minute slot

The structural mismatch is brutal. A proper ADHD assessment takes at least 90 minutes, often spread across several sessions, with extensive questionnaires and follow-up. Standard GP appointments run 15 minutes. Child and adolescent psychiatrist Dr David Chinn notes that thorough assessment typically requires about two hours plus access to escalation pathways for complex cases, none of which are funded under the new rules.

Dr Angus Chambers, chair of the General Practice Owners Association, does not mince words: “There is currently no funding allocation to GPs and primary health care to cover GP training and diagnosis of ADHD. So time spent on ADHD will be unsubsidised and therefore fully patient funded.” At typical private GP rates, he estimates assessment costs of $800 to $2,000, comparable to what private psychiatrists charged before the change. Chambers calls the policy “a bureaucrat’s way of changing the system with the stroke of a pen.”

The treatment gap has not moved

The unmet need is enormous. An estimated 250,000 to 350,000 New Zealanders have ADHD, but only 60,000 are on medication. Research shows 2.6% of adults have the condition but just 0.6% receive treatment, a gap exceeding 75%. Before the reform, waitlists exceeded two years in many districts and some DHBs were not assessing adult ADHD at all. Private assessment averaged $1,400, with some psychiatrists charging up to $2,000 per visit.

The equity dimension is worse. Adult Maori make up only 10% of ADHD prescription recipients despite being 17% of the population. An unfunded GP model that still costs patients hundreds of dollars will not close that gap.

Kent Duston, convenor of Aroreretini Aotearoa, describes the Ministry of Health’s position bluntly: “The Ministry of Health’s refusal to fund anything of any description for the ADHD community really is a pretty significant piece of discrimination.”

What this means for employers

This is not a niche clinical story. With roughly 5% of the population affected and fewer than a third treated, the pool of working-age adults carrying unmanaged ADHD is substantial. In practice, untreated ADHD translates into absenteeism, reduced productivity, higher turnover, and preventable co-occurring conditions including depression, anxiety, and substance use.

The reform was supposed to cut access costs and wait times. For business owners and HR managers hoping employees could finally get affordable diagnosis through their GP, the practical situation has barely shifted. Assessment still costs $800 to $2,000. Most GPs are not offering it. The bottleneck moved from specialists to general practice without the resources to clear it.

Psychiatrist Ben Beaglehole of the University of Otago puts the structural problem plainly: “We’ve fixed a lack of resourcing in the public system by having more people in the primary sector assess for ADHD. Ideally we also fix that with more resources for specialist mental health, and more paediatricians. But maybe that’s unrealistic even to say.”

It is not unrealistic to say. It is exactly what should have been said before the announcement, not after. A University of Canterbury thesis identified this pattern explicitly: policy changes announced without corresponding workforce planning and funding create implementation failures, a recurring feature of New Zealand health reform. The ADHD rule change is a textbook case. The government changed the rules, took the credit, and left a workforce already running at capacity to figure out the rest.

Sources

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