The Care Quality Commission has raised several concerns about patient safety and prescribing practices at a private medical cannabis clinic, following an inspection last year that identified multiple regulatory breaches.
In a report published in February, regulators found failures in safe care and treatment, governance and clinical oversight, warning that medicines were not always prescribed in line with current legislation or best practice.
An inspection of Alternaleaf clinic, which is run by Montu Group UK, took place in July 2025, with the watchdog issuing the provider a warning notice on 10 September 2025 for failing to comply with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Inspectors said that in some cases, patients were encouraged to select treatments from a wide range of cannabis-based products, ‘with no guidance on which types might be most suitable for their condition’ or review by specialist doctors.
The CQC also highlighted concerns about workforce pressures and coordination with other healthcare providers, with some staff members telling inspectors their workloads were ‘unmanageable or unsafe’ in the time given.
“There was a risk that staff would not have enough time to access all relevant information to safely prescribe and undertake any required follow-ups with patients and other healthcare professionals, for example, with patients’ GPs,” the report states.
“This system placed patients at risk of harm and clinicians at risk of not meeting the requirements of their professional registration.”
Concerns over clinical decision-making
The clinic operated a ‘shared care’ model designed to involve different professionals in patient care. However, the regulator said this approach ‘did not consistently ensure prescriptions were in line with legislation or best practice’.
The decision to initiate a prescription for cannabis-based medicinal products was taken by a specialist doctor, but the report found that patient cases were ‘not routinely reviewed by a multidisciplinary team, comprising another doctor with appropriate skills and experience to effectively determine and ratify unmet clinical need’.
Ongoing prescribing did not always involve specialist oversight, even when ‘significant changes’ were made to a patient’s treatment.
The report also identified a lack of clear governance structures, with roles and responsibilities not always well defined. In one case, inspectors found ‘no evidence of training or references’ for a specialist doctor who had been working at the service for six weeks.
While leaders at the service told inspectors their culture was to ‘put the patient first’, some staff reported feeling that the organisation was more ‘commercially focused’.
A spokesperson for Alternaleaf said that following the inspection, it has implemented a number of clinical and operational changes to ‘strengthen its service’ and had engaged in ‘constructive dialogue’ with the CQC to challenge some of the findings.
They told Cannabis Health in a statement: “The CQC inspected Alternaleaf in July 2025, 20 months after we started operating. We welcome their feedback as we continue to evolve alongside the UK’s wider medical cannabis sector.
“Since the inspection, Alternaleaf has proactively implemented a series of clinical and operational enhancements to further strengthen our service. While we have taken this opportunity to refine our internal processes, it is important to note that we have also engaged in a constructive dialogue with the CQC to challenge certain findings where we believe our existing practices already met high safety standards.”
Wider industry scrutiny
The findings come as private cannabis clinics are facing growing scrutiny in relation to how unlicensed cannabis-based medicines are being prescribed in the UK.
The ACMD is currently carrying out a review to determine whether there have been any ‘unintended consequences’ of the legislative changes introduced in 2018, which allowed these products to be prescribed by doctors on the specialist register.
An Alternaleaf spokesperson added that some of the issues highlighted in its CQC report are ‘sector-wide’ and ‘indicative of a rapidly maturing industry’.
As clinical standards and regulatory expectations for medical cannabis continue to evolve, we are committed to leading the way in establishing best practices,” they said.
“Our priority remains our patients. The CQC rated Alternaleaf ‘good’ for the way we respond to their needs, noting our personalised, flexible approach ‘maximises the effectiveness of people’s care and treatment’. This reflects our patient feedback – 87% tell us they’re satisfied with our service and over 4,000 have rated us excellent on TrustPilot.”
Updated guidance for best practice
Newly updated guidelines for best practice in medical cannabis prescribing, produced by the Medical Cannabis Clinicians Society (MCCS), reflect many of the concerns raised by the CQC, including the need for stronger oversight, clearer clinical accountability, and more consistent communication across services.
Chair of the MCCS, Professor Mike Barnes, said prescribing cannabis-based medicinal products requires “careful clinical judgement, a clear understanding of the evidence, and a strong awareness of professional responsibilities.”
The guidance states that patients should not be prescribed such medicines without a full review of their medical records and evidence that conventional treatments have been appropriately explored, and that decisions must be based on a ‘clear clinical rationale’ and ‘documented in detail’.
Communication with a patient’s wider care team, including their NHS GP and any relevant specialists, is described as a ‘core component of safe prescribing practice’, with clinicians expected to make ‘reasonable efforts’ to share treatment plans and gather relevant clinical information before prescribing.
The guidance also highlights the need for regular review and monitoring, noting that prescribing should be a ‘time-limited trial with clear outcome measures’, rather than an open-ended process.
The MCCS is clear that while patient preference should be considered, ‘the clinician retains ultimate responsibility for the prescription’, and that ‘it is not appropriate for patients to dictate specific products or doses without clinical agreement’.
While some are calling for mandatory best practice guidelines to be implemented by all private providers, the MCCS says its guidance is to ‘support, not replace’ formal regulation from bodies such as the GMC and CQC and is ‘not intended to limit clinical decision-making, but rather to support clinicians in applying their professional judgement’.
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Author: Sarah Sinclair
