England’s Medical Cannabis Market Concentrated in Handful of Doctors

New government data on England’s private cannabis prescribing shows that a small group of practitioners carries an outsize share of market volume — but the figure circulating in UK press needs considerably more context before it supports conclusions about clinical standards or market health.

The NHS Business Services Authority released the FOI-03587 dataset in March 2026 in response to a freedom of information request. It covers Schedule 2 and Schedule 3 cannabis-based medicinal products dispensed privately in England from January 2019 through May 2025. Dispensed items grew from 278 in 2019 to 663,130 in 2024 — a roughly 2,400-fold increase over five years. Monthly volumes in the first five months of 2025 averaged approximately 85,000 items.

The Concentration Numbers

Of 314 unique prescriber identifiers in the dataset, ten account for 805,255 items combined — 52.2% of the all-time total of 1.54 million. A single identifier is responsible for 172,755 items, or 11.2% of the total, and averaged approximately 9,189 items per month in early 2025.

That figure has been framed in the UK press as evidence that “ten doctors” wrote more than half of the country’s medical cannabis prescriptions. The NHSBSA’s own caveats make that characterization harder to sustain.

First, “items” in this dataset refers to the number of times a product appears on a prescription form — not the number of prescriptions issued, and not the number of patient consultations. One visit generating a prescription for three cannabis products produces three items. The Medical Cannabis Clinicians Society estimates an average of about two items per patient per prescription, though the figure varies significantly across prescribers.

Second, the data is unvalidated. CBPMs are identified through a manual review of prescriptions filed as “unspecified drugs” rather than through an automated system; completeness cannot be independently confirmed. Recent months are subject to change as reporting delays resolve.

Third — the most material caveat for anyone drawing conclusions about individual clinicians — the NHSBSA confirmed that it has not analyzed whether any of the pseudonymized identifiers in the dataset correspond to group accounts rather than individual clinicians. The authority stated that while most prescriber identification numbers are issued to individuals, group codes do exist in the system, and the disclosed data has not been reviewed to distinguish them. Two follow-up freedom of information requests submitted after early press coverage asked the NHSBSA to name the individuals behind the top-ten identifiers; both were refused on personal data protection grounds. The authority concluded that raw volume figures cannot be used to identify individuals when the data provides no clinical context and cannot distinguish high-volume repeat prescribing from new patient activity.

The NHSBSA also confirmed that supplementary calculations circulating alongside the dataset — including one estimating a per-minute prescribing rate derived from item totals and an assumed working week — were not produced by the authority and have not been validated by it.

A Market Built on Thin Infrastructure

The concentration story makes considerably more sense viewed as a market structure issue than as a function of any individual’s prescribing behavior.

Of approximately 100,000 doctors on the General Medical Council’s Specialist Register who are legally permitted to initiate cannabis prescriptions in the UK, only around 200 were actively prescribing in 2024. The market is operating on fewer than 1% of those eligible to participate. A private sector running on 200 active prescribers facing growing patient demand will, by structural logic, concentrate volume among those who have built the infrastructure to handle it — appointment systems, repeat prescribing workflows, and pharmacy relationships.

The concentration is also measurably declining. The Gini coefficient for prescriber distribution — a standard measure of how unevenly activity is spread across a population — peaked at 0.861 in 2022 and fell to 0.850 in 2024 and 0.775 in provisional data through May 2025. Active prescribers rose from 116 in 2022 to 200 in 2024, with 77 new entrants recorded in that year alone. The market is broadening its prescriber base, even if from a narrow starting point.

The data transparency problem runs alongside the structural one. The NHS England patient registry, launched in April 2022, was designed for clinicians working within NHS Trusts, effectively excluding more than 99% of prescribing volume that moves through private channels. Without mandatory private-sector reporting, the market has depended on freedom of information disclosures, unvalidated manual data capture, and voluntary registries run by individual operators. Patient demand continues to grow across conditions, including chronic pain, with the private sector absorbing patients who cannot access equivalent care through the NHS, while operators expand their clinical product range even as aggregate market data stays limited.

What Comes Next

The Advisory Council on the Misuse of Drugs has been commissioned to review the use and availability of cannabis-based medicinal products in England — a process the NHSBSA cited in both freedom of information refusal letters as the appropriate mechanism for assessing prescribing appropriateness. That review is expected to produce recommendations with regulatory weight.

For market participants, the operative questions are structural. What mandatory reporting requirements will follow? Will prescriber identifier data be reconciled to individual clinicians, closing the group-PIN ambiguity that sits at the center of the “ten doctors” framing? Will enforceable training standards be introduced? The MCCS’s Good Practice Guidance, updated in May 2026, acknowledges that “the absence of mandatory training and consistently applied clinical standards has led to variation in practice across the sector” — a direct admission from the clinician body most invested in the market’s legitimacy.

What today’s data confirms is that a small number of actors are carrying a disproportionate share of England’s private cannabis prescribing. What it cannot confirm is whether that concentration represents a governance problem, efficient specialization within a structurally constrained market, or a measurement artifact. The ACMD review will determine which interpretation drives policy.