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 Place Medicines Optimisation Committee (PMOC) 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
The Doncaster and Bassetlaw 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.
Red Status
Definition:
Initiation and ongoing prescribing should not be undertaken in primary care (unless as part of a specialist GPwSI service)
Rationale
- Requiring specialist assessment to enable patient selection, initiation and ongoing treatment
- Requiring long term on-going monitoring of efficacy by a specialist
- 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)
- Specifically designated as “hospital only “ by product licence or by DH
- 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
- That are hospital initiated clinical trial materials
- No prescribing information readily available.
- NICE guidance
Amber Status
Definition
Initiation and continued prescribing in primary care should only be undertaken under auspices of an agreed shared care protocol
Rationale
- Requiring specialist assessment to enable patient selection and initiation of treatment
- Requiring short or medium term (e.g. 3-6 months) specialist monitoring of efficacy or until the patient is stable.
- Requiring short or medium term specialist monitoring of toxicity
- That are very rarely used such that primary care practitioners are unlikely to see sufficient patients and acquire a working knowledge of the drug
- Specific long term monitoring for toxicity
- NICE Guidance
- Where an agreed shared care protocol exists
Amber Status with Guidance
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.
Green Status with Guidance
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.
Green Status
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.
Grey Status
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
- Evidence available supports that use in this area is inappropriate
- Insufficient evidence available to support its use in therapy
- Item withdrawn from market/discontinued
- Drug to be discussed at Doncaster Formulary Liaison Group/Medicines Management Committee or other groups before category agreed.
- A product for which the APC’s view of evidence of benefit over existing therapy does not justify routine availability.
