Bridging the Gap: What Integrated Care Really Means for Patients with Complex Needs

By Dr Sue Clenton, Consultant Oncologist and Medical Director at Releaf Cannabis Clinic

In her bi-weekly series for Cannabis Health, Dr Sue Clenton, Consultant Oncologist and Medical Director at Releaf Cannabis Clinic, shares her insight from the front line of an emerging field of medicine, taking readers inside the clinic and offering a doctor’s perspective on what it really means to prescribe cannabis medicines in the UK today.

Integrated care is frequently discussed in UK healthcare policy, often alongside promises of more coordinated treatment for patients with complex needs. But for many people living with chronic conditions, the reality often looks very different.

It is not uncommon for patients exploring treatment with medical cannabis to have multiple comorbidities and may already be under the care of several specialists, taking multiple medications. 

Many are turning to cannabis-based medicines or CBPMs as a last resort and often arrive at clinics like Releaf having exhausted all other options, usually having navigated complex healthcare pathways, spending years being referred between services and trying multiple different treatment options.

When determining whether this approach is appropriate for these patients, we must also consider how prescribing fits responsibly into their wider ecosystem of care.

No ‘typical’ medical cannabis patient 

One of the first things clinicians working in medical cannabis realise is that there is rarely a “typical” patient. Although we do see many physical complaints existing alongside mental health problems, due to the sheer burden of being chronically physically unwell. 

It may be that neurological conditions co-exist with psychiatric disorders, for example, which often leads to multiple specialties becoming involved and multiple drug regimens. 

In these situations, introducing any new treatment requires careful thought. It must fit into the patient’s existing care plan, safely and effectively, rather than adding another layer of complexity.

At Releaf Cannabis Clinic, complex or unstable patients will always stay under the care of our consultants. Only those whose conditions are more stable will move to shared care follow-up, with the option to return to consultant-led care if needed.  We are also looking to develop more specialised roles for our nonmedical prescribers to enable them to see more complex patients under the supervision of the consultants in that field.

Avoiding fragmentation through communication 

Shared decision-making becomes especially important in the context of complex needs. There is always a worry that introducing more agencies, whether private or NHS providers, will lead to more fragmented care. The more complex it becomes, the more difficult it is to ensure all are kept involved in discussions. 

From an integrated care perspective, everyone has a shared responsibility to ensure patient safety remains at the heart of their treatment. Clear communication and collaboration between the different specialties, healthcare providers, and patients is essential to ensure they receive the best possible care.

At Releaf, we communicate with patients’ GPs throughout the process to ensure they are kept informed of changes to their treatment plan. We also obtain permission from patients to discuss their case with specialists such as cardiologists, community mental health teams, and ADHD treatment providers.  

Governance to support collaborative decision making

For true integrated care, clinics need governance structures that support collaborative decision-making. These processes ensure complex cases are reviewed carefully and decisions are supported by clinical expertise across different specialties.

At Releaf, we have processes in place for making referrals between specialists within the clinic, for example, our neurologists and/or psychiatrists, and patients will have access to additional consultations if needed. Referral to other agencies should always be considered when necessary, too. 

Multi-disciplinary team (MDT) meetings are held for all new patients and complex decisions during follow-ups, alongside more informal daily discussions relating to clinical decision-making, with all relevant information provided to the patients’ GP and specialists if appropriate. 

Improvements in information sharing

However, even with the best intent, some major practical challenges remain, largely created by the separation between private and NHS services. 

As many patients have chosen to take this important step to improve their health, they are keen to engage with providers to help make the process as seamless as possible. But the current system sees cannabis-based treatments segregated into the private sector, making communications between the different healthcare providers trickier. 

While the safe and responsible prescribing of cannabis is ultimately down to the clinics, being able to access information from other specialists and agencies is crucial and changes in treatment plans and conditions should be seen by all.

Medical cannabis clinics should have direct access to patients’ NHS records, not only for information and decision-making purposes, but also for recording outcomes. All agencies would then be fully informed, improving communication streams and ultimately making treatment safer.

For integrated cannabis care to truly evolve, information sharing across the healthcare system must improve.