Beyond prescribing rights: designing equitable and sustainable attention-deficit/hyperactivity disorder care pathways in Aotearoa New Zealand.

AIM: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.