The UK medical cannabis sector is under increased scrutiny following a Care Quality Commission (CQC) inspection that identified multiple regulatory breaches at a private clinic. The CQC raised concerns regarding patient safety and prescribing practices at Alternaleaf, operated by Montu Group UK, as detailed in a report published in February.
The findings highlight issues in safe care and treatment, governance, and clinical oversight, indicating that medicines were not consistently prescribed in accordance with current legislation or best practice. This development contributes to wider discussions about clinical standards within the rapidly evolving UK medical cannabis sector.
CQC Findings and Regulatory Breaches
An inspection of Alternaleaf in July 2025 led to the CQC issuing a warning notice on 10 September 2025, citing non-compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The regulator’s report outlined several specific areas of concern:
- Patients were reportedly encouraged to select cannabis-based products without adequate guidance on suitability for their condition or specialist doctor review.
- Workforce pressures were identified, with some staff reporting unmanageable workloads, potentially impacting the time available for safe prescribing and patient follow-ups.
- The clinic’s ‘shared care’ model, intended to involve various professionals, did not consistently ensure prescriptions aligned with legislation or best practice.
- Patient cases were not routinely reviewed by a multidisciplinary team, and ongoing prescribing often lacked specialist oversight, even when significant treatment changes occurred.
- A lack of clear governance structures was noted, with roles and responsibilities not consistently defined. Inspectors found no evidence of training or references for one specialist doctor who had been working at the service for six weeks.
While clinic leaders stated a ‘patient first’ culture, some staff members indicated a perception of the organisation being more ‘commercially focused’.
Alternaleaf’s Response and Industry Context
A spokesperson for Alternaleaf stated that the clinic has implemented clinical and operational changes to strengthen its service since the inspection. The company also engaged in dialogue with the CQC to challenge certain findings, asserting that some existing practices already met high safety standards. The spokesperson further noted that some issues highlighted in the CQC report are ‘sector-wide’ and ‘indicative of a rapidly maturing industry’.
Despite the concerns, the CQC rated Alternaleaf ‘good’ for its responsiveness to patient needs, acknowledging its personalised and flexible approach.
This scrutiny of private cannabis clinics coincides with a review by the Advisory Council on the Misuse of Drugs (ACMD). The ACMD is assessing potential ‘unintended consequences’ of the 2018 legislative changes that permitted specialist doctors to prescribe unlicensed cannabis-based medicinal products in the UK.
Evolving Best Practice in Medical Cannabis Prescribing
In parallel with regulatory oversight, the Medical Cannabis Clinicians Society (MCCS) has issued newly updated guidelines for best practice in medical cannabis prescribing. These guidelines address many of the concerns raised by the CQC, advocating for stronger oversight, clearer clinical accountability, and more consistent communication across healthcare services.
Professor Mike Barnes, Chair of the MCCS, emphasised that prescribing cannabis-based medicinal products requires careful clinical judgement, a clear understanding of the evidence, and a strong awareness of professional responsibilities. Key recommendations from the MCCS guidance include:
- Conducting a full review of a patient’s medical records and confirming that conventional treatments have been appropriately explored before prescribing.
- Ensuring prescribing decisions are based on a clear clinical rationale and are documented in detail.
- Maintaining communication with a patient’s wider care team, including their NHS GP and relevant specialists.
- Implementing regular review and monitoring, treating prescribing as a ‘time-limited trial with clear outcome measures’.
- Clarifying that while patient preference is considered, the clinician retains ultimate responsibility for the prescription, and patients should not dictate specific products or doses without clinical agreement.
The MCCS clarifies that its guidance is intended to support, rather than replace, formal regulation from bodies such as the General Medical Council (GMC) and the CQC, aiming to assist clinicians in applying their professional judgement within the evolving regulatory landscape of the UK medical cannabis sector.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Hemp Gazette does not provide medical recommendations, diagnoses, or treatment plans. Always consult a qualified healthcare practitioner before making any decisions regarding your health or any medical condition. Statements concerning the therapeutic uses of hemp, cannabis, or cannabinoid-derived products have not been evaluated by Australia’s Therapeutic Goods Administration (TGA). Medicinal cannabis products in Australia are accessed via prescription pathways under TGA regulation.
