Using the MPD

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.

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.

8. Pathway in development

(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/guideline document

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. Shared care must be agreed by both parties and should not assumed. Note however, some shared care arrangements assume primary care will undertake shared care responsibilities unless they inform the specialist to the contrary. In such situations the primary care clinician should inform the
specialist and the patient in a timely manner with reasons for declining the shared care request.
Amber shared care medicines may be less familiar or used less frequently in primary care. The SY ICB MOT will alert primary care prescribers if any significant changes in review or monitoring arrangements of amber medicines they prescribe are recommended.

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 initiated 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.
Amber G medicines may be less familiar or used less frequently in primary care. The SY ICB MOT will alert primary care prescribers if any significant changes in review or monitoring arrangements of amber medicines they prescribe are recommended.
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
Please refer to the ‘Comments’ within the TLDL for each individual product information / criteria
*Specialist is defined as a clinician who has undertaken an appropriate formal qualification or recognised training programme, or who has the appropriate knowledge and competencies within the described area of practice

Green
These are medicines which are appropriate to be initiated and prescribed in primary and secondary care. They are generally familiar and frequently used medicines or for conditions generally managed in General Practice. Some medicines within this section may be started in primary care on the advice of a specialist or a clinician with specialist knowledge and training in area of care.
Primary care practitioners take full responsibility for initiating and ongoing prescribing, 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