TLS Category Key

Definition:

Initiation and ongoing prescribing should not be undertaken in primary care (unless as part of a specialist GPwSI service)

Rationale

1. Requiring specialist assessment to enable patient selection, initiation and ongoing treatment
2. Requiring long term on-going monitoring of efficacy by a specialist
3. Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty in recognising side effects or high cost of investigations to identify toxicity)
4. Specifically designated as “hospital only “ by product licence or by DH
5. That is either a new product or is a new indication for an existing product, which needs evaluation to be undertaken to establish place in therapy
6. That are hospital initiated clinical trial materials
7. No prescribing information readily available.
8. NICE guidance

Definition

Initiation and continued prescribing in primary care should only be undertaken under auspices of an agreed shared care protocol

Rationale

1. Requiring specialist assessment to enable patient selection and initiation of treatment
2. Requiring short or medium term (e.g. 3-6 months) specialist monitoring of efficacy or until the patient is stable.
3. Requiring short or medium term specialist monitoring of toxicity
4. That are very rarely used such that primary care practitioners are unlikely to see sufficient patients and acquire a working knowledge of the drug
5. Specific long term monitoring for toxicity
6. NICE Guidance
7. Where an agreed shared care protocol exists

Definition

Products must be initiated and where relevant titrated to stable dosage by a specialist before primary care practitioners take over prescribing responsibility. There may be a requirement for monitoring to be undertaken by the primary care practitioner as defined in relevant Amber G Guidance. Please refer to the Comments for each individual product.

Definition

Products for which primary care practitioners may take full responsibility for initiating and ongoing prescribing however, prescribing guidelines apply. Please refer to the Comments for each individual drug.

Definition

Products for which primary care practitioners may take full responsibility for initiating and ongoing prescribing however, they are subject to local formulary guidelines. Products in this category with appear in the TLS for 6 months from consideration only.

Definition

These products should not be initiated or prescribed on an NHS prescription in the Doncaster & Bassetlaw Health Care Communities unless in exceptional circumstances.

Rationale

1. Evidence available supports that use in this area is inappropriate
2. Insufficient evidence available to support its use in therapy
3. Item withdrawn from market/discontinued
4. Drug to be discussed at Doncaster Formulary Liaison Group/Medicines Management Committee or other groups before category agreed.
5. A product for which the APC’s view of evidence of benefit over existing therapy does not justify routine availability.