Pharmacists, Not Doctors, Lead England’s Cannabis Prescribing

Newly disclosed prescriber data has overturned a tidy story about England’s private medical cannabis market: that a tiny circle of doctors writes most of the prescriptions. The doctors are not the ones doing the writing.

Freedom of Information data released through the NHS Business Services Authority breaks down, for the first time, the professional type behind every cannabis-based medicinal product (CBPM) item dispensed privately in England between January 2019 and May 2025. Pharmacist independent prescribers, not specialist doctors, account for the bulk of the volume, and for nine of the ten highest-volume prescriber identifiers in the entire record.

That detail reframes who actually runs the market.

Inside the numbers

Of roughly 1.5 million identified items, pharmacist independent prescribers issued 955,471, or about 62% of the total. Doctors accounted for 553,218, or 36%, and nurse prescribers for the remaining sliver. Pharmacists make up only about a fifth of the identified prescribers but write more than three-fifths of the items, a split that points to a small number of high-volume operators rather than a broad base of clinicians.

The concentration is sharper at the top. Nine of the ten busiest prescriber identifiers are pharmacist independent prescribers. The single busiest, responsible for 172,755 items, or 11% of everything dispensed since 2019, is a doctor.

That figure needs care. The NHSBSA has confirmed it holds group identifiers — prescriber codes that can map to a clinic or practice rather than one named person — and it has not verified whether the ten busiest codes are individuals or organisations. The data is best read as a picture of a handful of large businesses, not ten unusually prolific people.

It does confirm the headline that first drew attention. In its response, the agency stated that ten prescribers together accounted for half of all private cannabis prescriptions between January 2019 and December 2025 — the finding earlier coverage framed as the work of a handful of doctors. Most of those ten are pharmacists.

Why pharmacists sit at the top

The explanation is in how the prescribing pathway is built. Since the law changed in 2018, only a doctor on the General Medical Council’s specialist register can start a patient on an unlicensed CBPM. Pharmacist independent prescribers are specifically barred from initiating one; the General Pharmaceutical Council’s guidance lists unlicensed medical cannabis, alongside a short set of addiction drugs, as the one thing a pharmacist prescriber cannot independently begin.

Once a specialist sets up the treatment, the law lets other prescribers take over the repeats under a shared-care arrangement. That is where the volume goes. In an established private clinic, the specialist initiates and a pharmacist independent prescriber issues the monthly refills, working inside parameters the doctor has set. The specialist base that has to sit at the front of every case remains thin, which is part of why operators have moved to widen it through free prescriber training.

Set that mechanic against the market’s shape and the numbers explain themselves. The UK’s private medical cannabis market runs largely on subscription telemedicine, where patients pay a recurring fee for ongoing consultations and repeat prescriptions. Industry analysts at Prohibition Partners estimate the eight largest telemedicine clinics handle roughly 80% of all CBPM prescriptions, serving an estimated 100,000 patients in 2025. A single pharmacist managing repeats across one of those subscription bases produces an enormous item count by design, which is what the top of the table shows.

What the data can’t settle

For operators, the reclassified story carries weight. Scrutiny of the sector has often been framed around individual prescribers; the data relocates it to the operating model of the largest clinics. Any tightening of shared-care rules or online-prescribing safeguards would fall heaviest on the subscription teleclinics that depend on pharmacist-issued repeats.

The disclosure also has real limits. The NHSBSA assembles this record by hand: private controlled-drug prescriptions arrive on paper, are scanned, and are keyed in by staff, with cannabis products first landing in an “unspecified drug” category before a later review reclassifies them. Codes that cannot be read are pushed into an unidentified-prescriber category. The agency cautions that the totals can shift and that some prescribing is undercounted, a familiar problem in a market with no central tracking system. It also declined to name the ten busiest prescribers, citing data-protection rules and the risk of prejudicing its own deliberations, while acknowledging the public interest in knowing whether the prescribing is appropriate.

That question now sits with the Advisory Council on the Misuse of Drugs, which has been commissioned to review the medical cannabis framework. The pharmacist-led model is legal by design. What the prescriber data cannot show is whether the specialist oversight the shared-care model depends on is consistently in place across the clinics that, between them, now write most of the country’s medical cannabis prescriptions.