Nine of the 10 Top CBPM Prescribers Are Pharmacists, UK FOI Data Shows

New data acquired by our sister publication, Business of Cannabis, has, for the first time, shed light on the professional types behind England’s CBPM prescribing record, raising further questions about assertions that ‘10 doctors prescribe half of the UK’s medical cannabis’. 

 

Earlier this month, Business of Cannabis published an independent analysis of the same data set used by The Times in its report, which detailed the volume of medical cannabis ‘items’ issued by each anonymised ‘prescriber identifier’ in the UK since 2019.

 

Now, thanks to an additional FOI request, we have a breakdown of the ‘prescriber type’ for all the 1.54m items prescribed over those six years.

 

Pharmacist independent prescribers accounted for 955,471 items between January 2019 and May 2025, 61.9% of the total items. Doctors, meanwhile, accounted for 553,218 items, or 35.8%. Nurse prescribers contributed a further 25,947 items.

 

Nine of the 10 highest-volume prescribers in the entire dataset are pharmacist independent prescribers. Only the single highest-volume identifier, responsible for 172,755 items, 11.2% of the all-time total, is a doctor.

 

The figure is almost certainly not a portrait of ten individuals. The NHSBSA has confirmed that group PINs exist, prescriber identifiers that may correspond to a clinic or group practice rather than a named individual, and has not verified whether any of the ten highest-volume identifiers in the dataset fall into that category.

 

Nine of the ten are pharmacist independent prescribers, whose volume is consistent with managing repeat prescriptions across large subscription patient bases. Prohibition Partners’ analysis shows that the top eight telemedicine clinics account for approximately 80% of all CBPM prescriptions.

 

The concentration the data shows is most plausibly read as a feature of market structure, a small number of large operators dominating a teleclinic-led market, not the prescribing habits of 10 people.

 

How the model works

Before breaking down the numbers, it is important to understand the standard clinical pathway that governs CBPM prescribing across the country.

 

Following the law change in 2018, only medical practitioners on the GMC Specialist Register may initiate a CBPM prescription.

 

Once treatment is established, ongoing prescribing passes to other appropriately qualified practitioners, including pharmacist independent prescribers, under a shared care arrangement.

 

As detailed in the latest edition of the MCCS Good Practice Guidance, the initiating specialist ‘defines clear parameters within a written treatment plan or policy, allowing follow-up prescribers to adjust dose and formulation in response to the patient’s clinical progress.’

These follow-up prescribers can be doctors not on the specialist register, independent prescribers like pharmacists, or nurses. The specialist retains overall responsibility, and the patient remains under their oversight even where prescribing is delegated.

 

In practice, for most patients in an established clinic, repeat prescriptions are issued by a pharmacist independent prescriber working within parameters set by a specialist doctor.

 

That model now operates at a significant scale. As mentioned above, the top eight telemedicine clinics are thought to account for approximately 80% of all CBPM prescriptions, with most operating subscription-based models in which patients pay a monthly or annual fee to receive ongoing consultations and repeat prescriptions.

 

A pharmacist independent prescriber managing repeat prescriptions across a large subscription patient base would, by design, generate a high item count.

 

Prohibition Partners estimates approximately 100,000 patients received medical cannabis treatment in 2025.

 

Graham Woodward, Chief Medical Officer at Releaf, believes the true figure is higher. “We have been talking about 50,000 patients for years, but I think we have at least 100,000 active patients in the industry, if not more,” he told Business of Cannabis.

 

Woodward also raises questions about the completeness of the prescribing record itself, stating: “The NHS prescription data is manually input. When a private prescription is fulfilled, it goes to NHS Business Services. Someone manually inputs what is on the prescription. If they don’t understand what it is, it goes into an ‘other’ box.

 

“I believe there are thousands and thousands of prescriptions going into ‘other’ and never being counted as cannabis prescriptions, because the people inputting the data manually do not know what the medication is.”

 

The NHSBSA has confirmed that all unlicensed CBMPs initially pass through an ‘unspecified drugs’ category before a secondary review identifies them as cannabis-based, a process that provides some safeguard against undercounting, though the authority has not been asked to confirm its completeness.

 

What the data cannot show is whether the governance structures that this shared care model depends on are consistently in place.

 

The MCCS guidance states that the initiating specialist should retain overall responsibility for the treatment plan, that patients remain under specialist oversight even where prescribing is delegated, and that a specialist is involved in the first follow-up before care transfers to a shared care arrangement.

 

The Care Quality Commission has flagged material concerns about oversight gaps and inconsistent multidisciplinary team practices at a number of private clinics.

 

While these clinics have a fundamental responsibility to maintain their quality of care and ensure patients are kept safe, the incoming ACMD review of CBPM prescribing must also assess the wider framework in the UK.

 

Primarily, whether a governance model that justifies pharmacist-led repeat prescribing at scale is reliably functioning across the clinics that now account for the majority of the market.