Expert Insights: GP’s perspective on medical cannabis prescribing in the UK

To continue on from last week's interview with our Head of Nursing Kim Kaye, this week we sat down to discuss the laws surrounding medical cannabis prescription in the UK with Releaf’s Dr Nick Bennett.

While Nick always knew he wanted to become a doctor growing up, he wasn’t quite sure what type of doctor he’d like to become, and originally went to medical school in York looking at Orthopaedic surgery. 

But while studying, Nick’s love for people, and the interactions involved in patient facing care, led him to General Practice, and the fit just felt right. 12 years on, Dr Nick Bennett still works as a GP for the NHS serving the community in Yorkshire he loves so much, but, he’s also able to support those further afield, thanks to his role at Releaf. 

Working from his family home in Wetherby two days a week, Dr Nick Bennett is also a Releaf practitioner, and may be a friendly face you recognise if you’re already a Releaf patient. If you’ve not yet had this pleasure, we’re pleased to make the introduction, and hope you’ll enjoy his insights on the prescription of medical cannabis in the UK as much as we do. 

Here’s what Dr Bennett had to say:

Dr Bennett, can you please explain the law in relation to GPs prescribing cannabis based treatments in the UK?

Sure. In the UK, GPs can prescribe cannabis-based treatments under the supervision of specialist constants through shared care agreements.

What this means is by law, GPs like myself, and prescribing nurses like Kim Kaye, can hold appointments with patients at private healthcare clinics like Releaf and write prescriptions for medical cannabis or cannabis oil, which are then signed off by a specialist doctor. 

Ultimately, this is because at the moment only those registered by the General Medical Council as a specialist can authorise medical cannabis prescriptions, and so after I’ve seen I’ve held my clinic hours I attend our daily multidisciplinary meeting and request the prescriptions I’ve written are signed off by one of the specialists we have on duty.

I do find it a bit bizarre because I would never prescribe anything I didn’t feel would be of benefit to somebody, and I would never prescribe anything I wasn’t confident of, but it’s a specific legislation that relates to medical cannabis. Just yesterday in my York practice, I sent off an electronic prescription for morphine - no specialist sign off required, because I’m more than qualified to do so. So, the stance with cannabis does feel peculiar, but we’re hoping this will change soon. 

Do you remember when you first really became aware of medical cannabis, or when you began to look into its benefits?

Probably only more so in recent years, I knew medical cannabis was legalised six years ago, but it’s so niche within the NHS, especially in terms of prescribing, I wasn’t really aware of the benefits medical cannabis may be able to offer those with things like chronic pain and mental health conditions until I started actively looking into it. 

Over the years in general practice, of course I’ve come across patients who have told me they’re using cannabis, but there was always been that question as to what degree they were doing this for medicinal reasons, and what the true motivations or intentions were, and I think that's the case for most doctors. 

But, when I saw an advertisement for a general practitioner position at Releaf, I was curious. It sounded really, really, interesting.

I did some further reading on cannabis-based therapies and thought it'd be a fantastic opportunity to help the kind of patients that I see frequently in general practice. Those who come to us repeatedly because they just can’t manage their conditions, or the treatments they’ve been prescribed really aren't satisfactory, and it’s just really impeding on their overall wellbeing and everyday life. 

It’s nice to be able to offer patients like this an alternative route now, and help them on their journey to getting better, and hopefully, even relieve some of the pressure off general practices around the country. 

And, what medical cannabis training or education have you undertaken in order to treat patients at Releaf?

When I joined Releaf the team had put together some really in-depth training packages and e-learning modules to complete. After that I did a lot of shadowing with different consultants in their appointments, sitting in on their clinics to see how they work, and sitting in on MDTs. I had a lot of close supervision and was always able to go over any questions I had. 

Then in the early days of me holding my own clinic hours, I was supervised by senior members of the clinical team to make sure everything I was doing was correct, and to the highest standard like Releaf strive for. There's always an on call clinician that's available to all the doctors at Releaf to speak to for further guidance or to ask any questions too, and I think that’s a fantastic practice to have in place.

Do you have a particular interest in any of the conditions that affects patients you see at Releaf?

As GP, I can see patients with all sorts of conditions, but I have got a particular interest in neurodiversity and I do get to meet with a lot of individuals who have autism or ADHD at Releaf. 

Diagnosis rates have increased substantially, and we’re seeing a lot more patients presenting to primary care facilities with these conditions, and then also at Releaf when traditional treatments have failed. So I particularly enjoy seeing these patients during Releaf follow-up consults because sometimes the results are, quite frankly, astounding.

I’ve seen lots of patients with ADHD in particular who have been really struggling. They’ve often received their diagnosis quite late in life, and they’ve been prescribed the usual stimulant medications. These do work for a lot of people, but for others it leaves them struggling to sleep for example, because their medication is actually too stimulating, or they can’t find the balance between what they need during the day and what they need at night, and so they have to forfeit one set of symptoms or side effects for the other. 

But when we can get the right prescription for them, the right concentration or combination of cultivars and correct dosages - it can be really, really powerful. We do have a few patient testimonials from individuals with ADHD on our website, and they’re really worth a read. 

How does your day-to-day life at Releaf compare to your role as a GP working for the NHS?

I think the most obvious difference is that the context is different. When patients have their first consultation with the doctors at Releaf, they know they’re very likely to be eligible for this course of treatment, they’ve often done a bit of research, and it's something they’re actively trying to pursue. Meanwhile, when patients present themselves to my York practice, they may be there for a myriad of reasons, and typically they’re not sure of what they’d like to try, or often, where to even start. 

But, of course, we still have to think about the other treatments patients are receiving, or any potential contraindications when designing treatment plans at Releaf, and so although we’re only prescribing from a cannabis-based formulary, it's not the only treatment type we’re thinking about!

Secondly, I’d say the way I interact with patients is different, because you have to adapt how you form a relationship with someone that you’ve never met in the flesh before. We’re trained in reading body language, and obviously through a screen that’s not quite the same. Nonetheless, it’s not tricky to get a good dialogue going as generally people feel comfortable in their own environment and in their own homes, and sometimes people find it easier to open up because of this. 

I think the last most noticeable difference is how the services operate, and how in control of their treatment plans patients are at Releaf. Unfortunately, in primary care facilities we quite frequently have patients ringing up in crisis because they can’t seem to get an appointment, or they can’t access a prescription, or are trying to request a repeat prescription or rewrite. But at Releaf, the patient account makes that all seamless and straightforward, and in turn, that really affects their overall experience with healthcare. 

What sort of reactions do you get from your NHS colleagues when you talk to them about medical cannabis or cannabis-based therapies?

They often look surprised, and I think that just reflects the problem: the lack of understanding and awareness of these options. While medical cannabis is relatively ‘new’ and niche, it is starting to break into the public sphere more now, and I do think people are becoming more aware. 

Doctors in primary care facilities are certainly starting to encounter patients using medical cannabis more frequently now, and they’re aware of this because when patients sign up for medical cannabis, they have to supply their medical records or SCR, and it's usually their GP that sends this over. At Releaf, we’ve also got a duty of care to inform practices that their patients are now receiving treatments from us too, and I think this is starting to make GPs more aware of just how many different conditions and symptoms can benefit from these options. 

But, in general, I’d say when you have a conversation with most people, once you explain how these treatments work and speak about the results that lots of individuals have had, people tend to understand why these options have been made available. 

And finally, what particular skills do General Practitioners bring to medical cannabis clinics like Releaf?

I think GPs in particular are trained to think in a holistic, all encompassing manner. It’s more than just thinking about one condition or one type of medication - be it medical cannabis or anything else - it's about the bigger picture. 

Having treated patients with all sorts of different conditions, in my experience there’s almost always an overlap between a primary condition and several other factors that affect an individual's quality of life. As doctors, we need to know not only how patients are managing with their condition and symptoms, but also, with their everyday life and wellbeing. 

Once we have the full picture, we’re able to support them in the right ways, and work to find a realistic approach that will benefit them as an individual. So, I really do feel it's important to have GPs working in this area of healthcare, and I wish more would join us because we’ve all got the same agenda at the end of the day: to care for and support people.