The UK’s medical hashish trade continues to be one of many quickest rising on the planet, with the newest figures from the NHS Enterprise Companies Authority (NHSBSA), printed in response to an FOI request, suggesting that the variety of gadgets for personal prescribing of unlicensed cannabis-based medicines rose from 6137 in September 2021 to 22,431 in September 2023.

Regardless of this development in affected person numbers, six years on from medical hashish’s legalisation within the UK, the variety of medical doctors in a position to prescribe medical hashish stays a significant bottleneck within the trade.

Enterprise of Hashish just lately sat down with Releaf’s Chief Working Officer, Graham Woodward, a educated psychiatric nurse and former scientific director and CQC Specialist Advisor, to debate the influence of this dynamic and the way clinics corresponding to Releaf are working to alter it.

BofC – Graham, with demand for medical hashish prescriptions on the rise within the UK, how essential is clinician coaching in assembly this demand from a industrial standpoint?

Graham – We’ve developed a very complete onboarding course of that goes past hashish coaching. It additionally contains normal coaching you’d anticipate in an NHS setting, corresponding to safeguarding, safety of weak adults, and even cybersecurity. We be sure that everybody who joins the group—not simply medical doctors—completes this coaching. We use a system referred to as Blue Stream, which covers the obligatory coaching required by the CQC and our personal inner requirements.

Alongside this, we offer coaching on our bespoke affected person portal. That is the platform clinicians use for assessments and follow-ups, and it’s the place sufferers can entry their prescriptions and different info.

Now we have a mixture of about 26 medical doctors on our staff, together with a few of the most skilled hashish prescribers within the nation, in addition to newer medical doctors simply starting their journey with hashish prescribing. It’s important to have people who find themselves genuinely eager about studying—not nearly hashish, however in regards to the situations it will probably deal with. Some clinicians are deeply curious in regards to the potential of hashish, whereas others nonetheless view it with skepticism, at the same time as one thing controversial.

Our coaching may be very thorough, with roughly six modules that cowl cannabinoids, minor cannabinoids, terpenes, sativas, indicas, CB1 and CB2 receptors, and far more. A few of our medical doctors have additionally accomplished exterior coaching applications, however we guarantee consistency by having new clinicians shadow extra skilled medical doctors. This helps them be taught the evaluation course of, learn how to introduce hashish as a remedy possibility, and undertake the ‘begin low, go sluggish’ method to prescribing.

BofC – How do you go about partaking ‘hashish naive’ medical doctors?

Graham – We actively recruit new prescribers via varied channels. On our web site, we’ve got a devoted software web page for these eager about prescribing. Moreover, we leverage LinkedIn, the place we publish alternatives and have interaction with our networks. In the beginning of the yr, for instance, we ran a LinkedIn marketing campaign inviting medical doctors to achieve out.

As a part of our efforts, we organized two webinars, every attended by round 30 medical doctors or potential prescribers. These periods included primary coaching and a Q&A phase. On the finish of the webinars, we invited contributors to contact us in the event that they have been eager about becoming a member of our staff.

Following that, we carried out one-on-one interviews with every physician to find out their suitability. It was a radical course of, very like any interview, to make sure we introduced on the precise candidates.

Phrase of mouth has additionally been instrumental in recruiting medical doctors. A lot of our present prescribers have beneficial colleagues primarily based on their constructive experiences with us. In a single notable case, a physician with 28 years of expertise as an oncologist within the NHS joined us full-time, leaving the NHS to give attention to hashish prescribing.

We provide all our medical doctors flexibility, with no less than one session per week, although many now do two, three, and even 4 periods. We encourage them to keep up ties with the NHS to remain present with developments, entry additional coaching, and improve their talent units.

Our multidisciplinary staff (MDT) conferences are one other cornerstone of our method. We maintain as much as three MDT conferences each day, relying on affected person quantity. These conferences deliver collectively skilled and new prescribers to debate instances, prescriptions, and remedy choices, fostering a collaborative setting.

Concerning the bottleneck of prescribing medical doctors, it’s true that the restricted variety of educated prescribers is a problem. There’s typically a disparity between the potential affected person demographic and the variety of medical doctors out there who’re geared up to prescribe. Whereas this is usually a limiting issue, our proactive recruitment, coaching applications, and collaborative setting assist us handle this hole and guarantee we’re regularly rising our capability to satisfy affected person wants.

BofC – How does this ‘bottleneck’ influence your skill to broaden?

Graham – It doesn’t maintain us again in any respect. We at the moment deal with roughly 100 new sufferers a day, which is a capability we intentionally keep to make sure each affected person receives high quality care.

We’ve scaled our operations to satisfy this degree of demand. To handle follow-ups and triages—which naturally enhance with 100 new sufferers a day—we’re specializing in recruiting extra nurses. Particularly, we’re seeking to onboard three extra non-medical prescribing nurses to enrich our current staff of two non-medical prescribing nurses and 5 GPs. In the meanwhile, we’re working at about 90% capability, and our staffing ranges are best.

We don’t face points with physician recruitment, although it’s doable this might change into a problem because the variety of clinics or sufferers will increase. If that occurs, we’ll proceed to leverage platforms like LinkedIn and our established networks to seek out appropriate candidates.

BofC – As we’ve simply talked about, it’s extremely essential to teach the medical aspect. However who do you suppose bears accountability for getting this performed?

Graham – I imagine the accountability for making certain correct coaching and assist lies squarely with us. Because the registered supervisor and nominated particular person below the CQC, I’m accountable for all of our sufferers and medical doctors.

In relation to coaching, I don’t foresee hashish, psilocybin, ketamine, or different novel remedies being included as normal modules in medical or nursing training anytime quickly. Till that occurs, we, as suppliers, should take full accountability for equipping our groups with the required information. We can’t defer to the NHS or any exterior physique for this—it’s our obligation as those delivering these remedies.

If the NHS have been ever to undertake medical hashish on a broader scale past present choices like Epidiolex, Sativex, and Nabilone, I imagine clinics like ours can be the pure selection to steer coaching and training.

BofC –You’ve talked about the significance of referring to analysis, have you ever seen analysis into hashish enhance through the years you’ve been working within the trade as entry has been liberalised?

Graham – That’s an incredible query, and whereas I haven’t seen a lot traditionally, we’ve just lately had an thrilling growth. Leeds College approached us to collaborate on a research investigating the results of hashish on lengthy COVID. With an estimated 380 million individuals globally affected by lengthy COVID, it is a important space of analysis. This partnership is a significant step ahead for us as a clinic, as we’ve by no means been approached by a college for a research earlier than.

The research is deliberate as a one-year pilot with 150 sufferers who’ve lengthy COVID. Leeds College is taking the lead on the moral framework, and the scientist spearheading the research is very skilled. It’s not a pricey endeavor however might yield invaluable insights.

At this stage, I imagine the main target ought to shift in the direction of real-world proof, leveraging the info we have already got from sufferers. Medical trials, whereas invaluable, won’t be essentially the most sensible route for advancing hashish analysis within the UK. Globally, we see promising research from international locations like Canada, Israel, and Germany. Australia is contributing as properly, though a few of their findings are much less constructive.

Whereas there’s nonetheless a protracted technique to go, the truth that we’re starting to see collaborations with universities and extra analysis alternatives rising within the UK is an encouraging signal.