From Specialists to GPs: Releaf on Expanding Access to Medical Cannabis Training in the UK

The UK’s medical cannabis industry continues to be one of the fastest growing in the world, with the latest figures from the NHS Business Services Authority (NHSBSA), published in response to an FOI request, suggesting that the number of items for private prescribing of unlicensed cannabis-based medicines rose from 6137 in September 2021 to 22,431 in September 2023.

Despite this growth in patient numbers, six years on from medical cannabis’s legalisation in the UK, the number of doctors able to prescribe medical cannabis remains a major bottleneck in the industry.

Business of Cannabis recently sat down with Releaf’s Chief Operating Officer, Graham Woodward, a trained psychiatric nurse and former clinical director and CQC Specialist Advisor, to discuss the impact of this dynamic and how clinics such as Releaf are working to change it.

BofC – Graham, with demand for medical cannabis prescriptions on the rise in the UK, how crucial is clinician training in meeting this demand from a commercial standpoint?

Graham – We’ve developed a really comprehensive onboarding process that goes beyond cannabis training. It also includes standard training you’d expect in an NHS environment, such as safeguarding, protection of vulnerable adults, and even cybersecurity. We ensure that everyone who joins the organization—not just doctors—completes this training. We use a system called Blue Stream, which covers the mandatory training required by the CQC and our own internal standards.

Alongside this, we provide training on our bespoke patient portal. This is the platform clinicians use for assessments and follow-ups, and it’s where patients can access their prescriptions and other information.

We have a mix of about 26 doctors on our team, including some of the most experienced cannabis prescribers in the country, as well as newer doctors just beginning their journey with cannabis prescribing. It’s critical to have people who are genuinely interested in learning—not just about cannabis, but about the conditions it can treat. Some clinicians are deeply curious about the potential of cannabis, while others still view it with skepticism, even as something controversial.

Our training is very thorough, with approximately six modules that cover cannabinoids, minor cannabinoids, terpenes, sativas, indicas, CB1 and CB2 receptors, and much more. Some of our doctors have also completed external training programs, but we ensure consistency by having new clinicians shadow more experienced doctors. This helps them learn the assessment process, how to introduce cannabis as a therapy option, and adopt the ‘start low, go slow’ approach to prescribing.

BofC – How do you go about engaging ‘cannabis naive’ doctors?

Graham – We actively recruit new prescribers through various channels. On our website, we have a dedicated application page for those interested in prescribing. Additionally, we leverage LinkedIn, where we post opportunities and engage with our networks. At the start of the year, for example, we ran a LinkedIn campaign inviting interested doctors to reach out.

As part of our efforts, we organized two webinars, each attended by around 30 doctors or potential prescribers. These sessions included basic training and a Q&A segment. At the end of the webinars, we invited participants to contact us if they were interested in joining our team.

Following that, we conducted one-on-one interviews with each doctor to determine their suitability. It was a thorough process, much like any interview, to ensure we brought on the right candidates.

Word of mouth has also been instrumental in recruiting doctors. Many of our current prescribers have recommended colleagues based on their positive experiences with us. In one notable case, a doctor with 28 years of experience as an oncologist in the NHS joined us full-time, leaving the NHS to focus on cannabis prescribing.

We offer all our doctors flexibility, with at least one session a week, though many now do two, three, or even four sessions. We encourage them to maintain ties with the NHS to stay current with developments, access further training, and enhance their skill sets.

Our multidisciplinary team (MDT) meetings are another cornerstone of our approach. We hold up to three MDT meetings daily, depending on patient volume. These meetings bring together experienced and new prescribers to discuss cases, prescriptions, and treatment options, fostering a collaborative environment.

Regarding the bottleneck of prescribing doctors, it’s true that the limited number of trained prescribers is a challenge. There’s often a disparity between the potential patient demographic and the number of doctors available who are equipped to prescribe. While this can be a limiting factor, our proactive recruitment, training programs, and collaborative environment help us address this gap and ensure we’re continually growing our capacity to meet patient needs.

BofC – How does this ‘bottleneck’ impact your ability to expand?

Graham – It doesn’t hold us back at all. We currently handle approximately 100 new patients a day, which is a capacity we deliberately maintain to ensure every patient receives quality care.

We’ve scaled our operations to meet this level of demand. To manage follow-ups and triages—which naturally increase with 100 new patients a day—we’re focusing on recruiting more nurses. Specifically, we’re looking to onboard three additional non-medical prescribing nurses to complement our existing team of two non-medical prescribing nurses and five GPs. At the moment, we’re operating at about 90% capacity, and our staffing levels are ideal.

We don’t face issues with doctor recruitment, though it’s possible this could become a challenge as the number of clinics or patients increases. If that happens, we’ll continue to leverage platforms like LinkedIn and our established networks to find suitable candidates.

BofC – As we’ve just mentioned, it’s incredibly important to educate the medical side. But who do you think bears responsibility for getting this done?

Graham – I believe the responsibility for ensuring proper training and support lies squarely with us. As the registered manager and nominated individual under the CQC, I am accountable for all of our patients and doctors.

When it comes to training, I don’t foresee cannabis, psilocybin, ketamine, or other novel treatments being included as standard modules in medical or nursing education anytime soon. Until that happens, we, as providers, must take full responsibility for equipping our teams with the necessary knowledge. We cannot defer to the NHS or any external body for this—it is our obligation as the ones delivering these treatments.

If the NHS were ever to adopt medical cannabis on a broader scale beyond current options like Epidiolex, Sativex, and Nabilone, I believe clinics like ours would be the natural choice to lead training and education.

BofC –You’ve mentioned the importance of referring to research, have you seen research into cannabis increase over the years you’ve been working in the industry as access has been liberalised?

Graham – That’s a great question, and while I haven’t seen much historically, we’ve recently had an exciting development. Leeds University approached us to collaborate on a study investigating the effects of cannabis on long COVID. With an estimated 380 million people globally suffering from long COVID, this is a significant area of research. This partnership is a major step forward for us as a clinic, as we’ve never been approached by a university for a study before.

The study is planned as a one-year pilot with 150 patients who have long COVID. Leeds University is taking the lead on the ethical framework, and the scientist spearheading the study is highly experienced. It’s not a costly endeavor but could yield valuable insights.

At this stage, I believe the focus should shift towards real-world evidence, leveraging the data we already have from patients. Clinical trials, while valuable, might not be the most practical route for advancing cannabis research in the UK. Globally, we see promising studies from countries like Canada, Israel, and Germany. Australia is contributing as well, although some of their findings are less positive.

While there’s still a long way to go, the fact that we’re beginning to see collaborations with universities and more research opportunities emerging in the UK is an encouraging sign.