Summary of recommendations:
i. A UK-wide paediatric specialist clinical network should be established to provide specialist clinical expertise, support discussion of complex cases, provide support to clinicians and to assist in evidence generation.

ii. The National Medical Director and Chief Pharmaceutical Officer for England will write to doctors and pharmacists reminding them of General Medical Council (GMC) guidance on the prescribing and use of unlicensed medicines – and to clarify the procedure for prescribing and supplying cannabis-based products for medicinal use (CBPMs). Clinicians will also be made aware of how they can access the Health Education England (HEE) cannabis education package, commissioned by NHS England, and published alongside this report.

iii. NHS England and NHS Improvement and the Department of Health and Social Care (DHSC) should work together to develop clear information for patients and patient groups on the prescribing of cannabis-based products for medicinal use.

iv. The National Institute for Health Research (NIHR) should support research into the five priority research areas that have been identified by the draft National Institute for Health and Care Excellence (NICE) clinical guideline on the use of cannabis-based products for medicinal use.

v. For severe treatment-resistant paediatric epilepsy, evidence generation should be in two forms:
- Support one or more randomised control trials (RCTs) using a standardised approach with several comparative treatment arms.

- NHS England and NHS Improvement and NIHR in conjunction with the specialist network will work together to determine an appropriate alternative study design that will enable evidence generation for those patients who cannot be enrolled into a standard RCT. This scope of study should include those children and young adults who are currently in receipt of a CBPM.

vi. These should commence as soon as possible, pending ethical review, and if necessary the alternative study should commence in advance of the RCT.

vii. NHS England and NHS Improvement, DHSC and Devolved Administrations should work with industry and academia to scope the development of a national UK patient registry to collect a uniform data set, across all indications, for patients prescribed a cannabis-based product for medicinal use in the United Kingdom.

viii. NHS England and NHS Improvement will also explore how to update the National Genomic Test Directory so that whole genome sequencing would be offered to all children with severe treatment-resistant epilepsy under consideration for treatment with medical cannabis.

ix. DHSC and Medicines and Healthcare products Regulatory Agency (MHRA) should work to provide access to information on good quality products, manufactured to Good Manufacturing Practice standard and with consistent ratios of cannabidiol (CBD) to delta-9-Tetrahydrocannabinol (THC) between batches.

x. NHS England and NHS Improvement should work with suppliers to ensure that sufficient stock of good quality CBPMs are available and that the products available offer the best value for the NHS, including scoping options for UK manufacture.