Late last year Karsons Pharmacy in Onchan became the first on-island dispensary for medicinal cannabis products, but how people access those products has been not been clear.
Medicann had been due to launch an on-island clinic to issue prescriptions – it was even being warmly received by ministers – but at some point, it appears something changed.
Going back to March 29, 2022, the Department of Health and Social Care was looking for a partner of its on-island dispensing service, as it sought a 12-month pilot scheme.
In that press release, it said: ‘Isle of Man residents seeking CBMP (Cannabis Based Medicinal Products) will need to do so via a private prescription from a private clinic in the United Kingdom or Crown Dependencies, by clinicians who are on the Specialist Register of the General Medical Council (GMC) and who can prescribe such products.’
Almost exactly the same wording was used in a further press release, announcing that Karsons had been awarded the dispensing contract, on June 23, 2022.
That statement said: ‘Isle of Man residents seeking cannabis based medicinal products will need to do so via a private prescription from a private clinic in the United Kingdom or Crown Dependencies, by clinicians who are on the Specialist Register of the General Medical Council (GMC) and who can prescribe CBPMs.’
Throughout the year, Health Minister Lawrie Hooper was in talks with Medicann. On August 1, 2022, he wrote to the company, saying it was ‘really positive to see your plans progressing and good to see you having a physical base here on island’.
However, by the end of August, there seemed to be issues, as delays became inevitable, something that Medicann said wasn’t explained.
Mr Hooper said in an email to the company that, quite rightly, the ‘DHSC is more concerned about getting this right, than getting it done quickly and we are content to proceed at the right pace for Karsons, who are the licensed organisation in this process’.
He also referred to it being ‘unfortunate’ that the company had invested money into the island without the dispensing service being read, but said that proper procedures would be followed and the service wouldn’t be rushed.
At the time, Medicann said it had more than 100 people waiting for its clinic to launch and it needed to provide them with details about what was happening.
By October 2022, Rob Callister had been appointed DHSC Minister and was now involved in discussions with Medicann.
On October 10, the company wrote to him saying that a presentation, understood to have been for Tynwald members, ‘went very well right up until the end’.
The email to Mr Callister said: ‘I refrained from getting into an argument with your fellow member, however he was 100% incorrect in his accusation and I would like to clarify why. He stated that we were well aware we had to be registered with the CQC as it was in the tender (this was 100% incorrect, the tender was for dispensing pharmacy and not a clinic and as such there was not should there have been any reference to the CQC, after the meeting a lady doctor who is now an MHK [presumably Dr Michelle Haywood] stated that she had been in conversation the Lawrie and she also confirmed that the tender categorically stated that we had to be registered with the CQC.’
The company said the claim about being CQC registered was ‘factually incorrect and misleading’ and asked for ‘the attendees to be informed if possible as I felt the statement undermined the presentation and made ourselves look to be avoiding the CQC requirement.’
The CQC, Care Quality Commission, is the independent regulator of health and adult social care in England.
It has no remit or powers outside England. So it cannot regulate in Scotland, Wales, Northern Ireland, Jersey, Guernsey and the Isle of Man.
Following the launch of the prescriptions on the island, people who had used Medicann’s clinic were told that their prescriptions were invalid.
An email on October 28 from William McCann, the DHSC’s head of strategic commissioning confirmed in an email to Medicann that Karsons was able to work only with ‘private clinics who are CQC registered and regulated’.
He added: ‘This means that for the pilot (12 to 18 months) it is restricted to UK clinics. As you quite rightly mentioned, the CQC does not regulate outside the UK.
‘During the pilot, our registrations and inspection function is looking at how I can build the equivalent regulatory system (that essentially mirror the CQC UK) in order to consider expanding the registration of private clinics here on the island.
‘At the very outset of the quote process we had identified that the governance systems within our current regulatory function just aren’t mature enough at this stage to provide the reassurances required in this sector.’
In response, the company said this was ‘very disappointing and against all communications we have had in the last 18 months’ but that it wanted to ‘put the past behind us and move forward’.
It added: ‘We already work in partnership with the leading CQC registered UK clinics and therefore can work within your new guidelines.’
Prior to the publication of a freedom of information request from our sister website Gef.im, the DHSC said it has ‘stipulated that the pharmacy with the licence to dispense will only be able to accept prescriptions from private prescribing clinics who are CQC inspected and approved’.
A spokesperson added: ‘The stipulation of working with CQC inspected and approved clinics is to ensure an appropriate governance framework exists that will provide further assurances of a safe and well led service – particularly in a sector where unlicensed CBMPs do not come with regulatory approval in respect of safety, quality or efficacy.
‘As part of the pilot, the department will consider the feasibility of broadening out the regulatory requirement to enable the expansion of clinics that people will be able to utilise. The department is happy to liaise, advise and engage with Medicann or any other provider in this sector who plan to operate from the island in the future.’
Medicann is now linking up its clients with a clinic in England that is CQC-registered, enabling them to access the prescriptions from Karsons, but the issue of when the CQC requirement became part of this trial is still unclear.
Despite the DHSC saying it has always been the case, Medicann has continued to dispute this.
In its May and June 2022 press releases the DHSC said a clinic based in the UK or Crown Dependencies could offer prescriptions. It appears that either this did change at some point, or the DHSC was unaware the CQC doesn’t have powers outside of England.
However, the latter possible explanation doesn’t correlate with the DHSC and Manx Care previously saying that when the CQC reviewed services on the Isle of Man, it couldn’t regulate on the island and that ‘services on the IOM will not be registered by CQC’.
It does appear that at some point things did change, even if only because regulations needed to be strict for the trial period, either way, both versions of this story can’t be right, either the DHSC is wrong or Medicann is.
The trial period began in December 2022 and will run for the next year or so.