The harmonisation of place-based Traffic Light Drug List (TLDL) is underway with the long-term vision to have one TLDL for South Yorkshire.
All the medicines and products on the MPD have been agreed via either the Doncaster and Bassetlaw Area Prescribing Committee (APC) or the South Yorkshire Integrated Medicines Optimisation Committee (IMOC) so rationales may differ slightly as work to harmonise the place based TLDL continues. For all medicines and products agreed via the SY IMOC from February 2023 the below rationale applies. For all medicines and products previously agreed at Doncaster and Bassetlaw APC please see below :-
The traffic light status of medicines that have not been reviewed by IMOC or APC should not be assumed. Clinicians can seek advice from their ICB Medicines Optimisation team if requested to prescribe medicines that are not captured in place or SY TLDLs.
The TLS is now housed on the Medicines and Product Directory (MPD) To access click the link on the MPD home page
Please be aware if a product does not appear on the TLS it does not automatically mean that it has GREEN status.
A TLS for a product should not be taken as an indication of its inclusion in the formulary. Reference the local formulary guidance and/ or click “read more” for a product prior to prescribing to ascertain formulary status.
The Traffic Light System (TLS) is a colour coded system which provides guidance on prescribing responsibilities and commissioning intention for selected products.
It aims to provide clear understanding of where clinical and prescribing responsibility rests between specialists and primary care practitioners should a product be prescribed.
Note: The guidance on the Traffic Light System has been agreed with Doncaster & Bassetlaw clinicians, and therefore may not always mirror guidance produced outside of this local area. Criteria for the inclusion of medicines on these lists, or the moving of medicines between the TLS categories, will be primarily based on:
- Evidence base
- Clinical competence and experience
- Patient safety
- Monitoring and follow-up requirements of the drug and/or the condition
Traffic Light Drug List Key (TLDL)
This indicates the TLDL status given by the NHS South Yorkshire Integrated Medicines Optimisation Committee (IMOC) or Doncaster and Bassetlaw Area Prescribing Group (APC). The TLDL status clarifies where a medicine or product should be prescribed in Primary and Secondary Care taking into account national and local guidance, monitoring requirements and any other specific information.
Grey, Red and Amber status give details of rationale to clarify the reason behind the status choice.
SY IMOC Traffic light status Criteria
Grey
The use of medicines/products in the grey list should not be initiated in South Yorkshire unless exceptional circumstances apply. Patients who are already prescribed medicines/products within the grey list should be reviewed and alternative treatment options considered, in line with most recent evidence.
Rationale/criteria;
1. There is a clear national guidance (e.g. NHS England Specialised Commissioning) to not routinely fund usage of the medicine/product.
2. There is clear national evidence (e.g. NICE ‘do not do’s’) to not routinely prescribe this medicine/product on the NHS.
3. Medicine/product of low clinical effectiveness, where there is a lack of robust evidence of clinical effectiveness or there are significant safety concerns.
4. Medicine/products which are clinically effective but where more cost-effective products are available, including some products that have been subject to excessive price inflation.
5. Medicines/products which are clinically effective but due to the nature of the product are deemed a low priority for NHS funding.
6. Medicines/products where clinical evidence is in development (e.g. NICE guidance) and awaiting final committee approval.
7. Evidence not evaluated. Local clinicians who wish to change Traffic Light Status complete application form.
(Reference NHSE items that should not routinely be prescribed)
Red
Initiation and ongoing prescribing of the medicine/product should be undertaken by secondary care/specialist.
Rationale/criteria;
1. Requires specialist assessment to enable patient selection, initiation, ongoing treatment and monitoring of efficacy, toxicity or adverse effects.
2. Specifically designated as “hospital only “by product licence or by DH as per drug tariff.
3. A new medicine/product or new indication for an existing medicine/product which needs specialist evaluation to be undertaken to establish place in therapy.
4. Hospital initiated clinical trial materials used in accordance with the trial protocol
5. Not listed in the current BNF or BNF / no prescribing information readily available.
6. Being used to treat a condition that is not suitable for primary care prescribing because of defined commissioning arrangements
7. Awaiting shared care guideline.
Amber – Shared care
Local shared care guidelines/protocols in place. Medicines/products that are initiated by a specialist but are suitable for primary care prescribing under a shared care agreement.
Rationale/criteria;
1. Requiring specialist assessment to enable patient selection and initiation of treatment, as defined within each shared care protocol (SCP).
2. Requiring a period of monitoring by the specialist (as defined within each SCP) to assess efficacy and safety of medication
3. Ongoing oversight of a specialist is required to assess continued efficacy and safety (e.g. long term monitoring of toxicity/degenerative conditions).
4. Medicine/product is subject to specific NICE guidance.
Amber G
Local or national Guidelines to support ongoing prescribing in primary care. Medicines/products that are must be initiated or recommended by a specialist but are suitable for primary care to continue and take over ongoing prescribing responsibility. The specialist to provide the primary care clinician with necessary information and support in order for treatment to be managed safely in primary care.
Rationale/criteria;
1) Requiring specialist assessment to enable patient selection and initiation of treatment.
2) Specialist to either;
a) titrate to a stable dose or
b) titrate to a point at which handover is suitable before primary care practitioners take over prescribing responsibility in line with locally agreed guidance clarifying shared prescribing and monitoring responsibility or
c) request primary care to initiate
Please refer to the ‘Comments’ within the TLDL for each individual product information / criteria
Green
These are medicines which are familiar and frequently used in General Practice. Primary care practitioners may take full responsibility for initiating and ongoing prescribing, subject to local formulary guidelines. Where there are local guidelines to support prescribers, these will be linked within the TLDL.
Due to the extensive number of green drugs, currently not all will be listed within the SY TLDL. If clarification is needed for a medicine not listed in the TLDL clinicians can seek advice from their place ICB Medicines Optimisation team.
The Doncaster Place TLS categories are as follows but may change in line with SY ICB in the future
Each product is classified under one of the following categories:
Red, Amber, Amber with Guidance, Green, Green with Guidance or Grey.
The category it is placed in determines the circumstances in which it is recommended to be prescribed (or not) and any guidance/rationale which needs to be taken into consideration.
Review of the product and its classification takes place when new guidance/information is released on the product. Alternatively, a request for a new TLS or a revision of an existing TLS can be made via this form:
To place a request for review or consideration of TLS status click here
Click on the coloured boxes below for definition & rationale explanations.