Beyond Prescribing Rights: Designing Equitable and Sustainable Attention-deficit/hyperactivity Disorder Care Pathways in Aotearoa New Zealand

The New Zealand medical journal  ·  2026

Steven Lillis; Lara Oertly; Belinda Wheaton; Byron Rangiwai; Nicholas Bowden; Stephanie D'Souza;

HIGHLIGHT

From February 2026, vocationally trained general practitioners and nurse practitioners in Aotearoa New Zealand are authorised to initiate stimulant medication for adults with attention-deficit/hyperactivity disorder (ADHD), marking a shift from a predominantly secondary care model. This viewpoint article examines the clinical, ethical and service-level implications of this regulatory change, with particular attention to equity, diagnostic quality, cost and sustainability in primary care.

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ABSTRACT

From February 2026, vocationally trained general practitioners and nurse practitioners in Aotearoa New Zealand are authorised to initiate stimulant medication for adults with attention-deficit/hyperactivity disorder (ADHD), marking a shift from a predominantly secondary care model. This viewpoint article examines the clinical, ethical and service-level implications of this regulatory change, with particular attention to equity, diagnostic quality, cost and sustainability in primary care. This viewpoint draws on Aotearoa New Zealand policy documents, international clinical guidance and selected peer-reviewed literature to inform a policy and equity-focussed analysis of expanded stimulant prescribing authority. The policy change has the potential to improve access to ADHD treatment; however, the absence of mandated training, competency standards or operational guidance raises concerns about diagnostic quality, management of comorbidity and prescribing safety. The time-intensive nature of adult ADHD assessment presents workload and resourcing challenges for primary care, and multiple service delivery models are likely to emerge with variable equity implications. Expanded prescribing authority may improve access, but without appropriate training, resourcing and implementation frameworks, benefits may be unevenly realised. Clear standards and equity-centred service design are essential.

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