Traffic Light System for Drug Classification
Guidance in this document serve to define where clinical and prescribing responsibilities for the listed drugs should lie.
It is intended that this system will provide guidance on the use of medicines across the interface between primary and secondary care. It provides a framework for defining where clinical and therefore prescribing responsibility should lie through categorisation of individual drugs. The list is only advisory but is intended to clarify expectations of prescribing responsibility.
Red
For specialist use in secondary / tertiary care (see Appendix 1 of Surrey Interface Prescribing Policy)
Amber
Prescribing to be initiated by a hospital specialist (or if appropriate by a GP with specialist interest) but with the potential to transfer to primary care when:
● an individual GP has agreed to accept clinical responsibility for an individual patient.
● agreed shared care arrangements have been established and the GP is willing to take over shared care
● the patient’s condition and/or treatment has been stabilised
● In one off situations, a specific GP can agree to enter into a ‘shared care arrangement’ without a formal shared care guideline providing a letter is sent to the GP giving appropriate advice and guidance
● the request is accompanied by a written proposal that the GP is happy to accept. This may take the form of a shared care guideline or other written communication. For a drug that is regularly transferred from secondary to primary care then a formal shared care protocol should be set up, however for a one off arrangement with one GP then a letter containing appropriate advice and guidance should be sufficient. The key principle is that the GP is provided with the information and given the opportunity to accept prescribing responsibility before transfer takes place. These drugs should be initiated and prescribed by a secondary care specialist until patient is stabilised on treatment in order to monitor the patient’s response, adjust dosage and treat side effects. Once the patient is stabilised (usually within 3 months but see individual shared care protocols) the GP can be asked to agree shared care.
Amber*
Drugs that in principle are in the amber category but due to more widespread experience in primary care GPs are generally happy to prescribe on specialist advice without the need for a formal shared care protocol. These drugs will have information sheets available on the internet (www.surreyhealth.nhs.uk) forming part of Surrey PCT's traffic light document giving GPs appropriate advice / guidance. It is therefore not necessary for the specialist to send a copy to the GP for individual patients with the clinic letter (work ongoing in producing these information sheets and in the interim a more detailed clinic letter will suffice). A minimum of one month supply of medication will be provided by the initiating consultant.
Green
These are drugs that can be initiated and continued in primary, secondary or tertiary care. By default any drugs not listed under red or amber should be considered green (providing that they are included with the Acute Trust formulary).
Black
These are drugs that have been reviewed by the Surrey Area Prescribing Committee and have been considered as not suitable for routine prescribing within Surrey. They are therefore not routinely recommended for prescribing in Primary or Secondary Care. This may be due to lack of good clinical evidence, cost effectiveness/concerns over safety or due to the availability of more suitable alternatives.
As such Black Drugs are considered as non-formulary in the Surrey Acute TrustsNew Drugs
As soon as a new drug / new licensed indication is added to an acute Trust formulary the category the drug falls into will be specified and added to this table (including green category). Any drug classified as green however will only be included in the table for 1 year.
Paediatric Prescribing
A lot of medicines initiated by the paediatricians in secondary care are unlicensed but their use is medically accepted practice. Providing that the drug, indication and dose is included in the Children’s BNF then a shared care protocol is not required in order for transfer across to primary care to take place.
Implementation
This is a new system for Surrey PCT and there is still a large amount of work to be completed in producing all the shared care protocols and information sheets. In the interim GPs should not amend their current practice. When a new shared care protocol is ratified it should be noted that the eligibility criteria applies only to new patients commencing treatment and not to existing patients whose treatment was initiated previously whilst the monitoring and discontinuation criteria applies to all patients.
Traffic Light System for Surrey Primary Care Trust
Please follow the links to the traffic light system. The pharmaceutical commissioning team at Surrey PCT will be updating the traffic light system regularly to ensure that all relevant decisions made at local drugs & therapeutics committees are communicated to prescribers via this document.
Click here to view the Traffic Light System
Shared Care Documents
The Pharmaceutical commissioning team at Surrey PCT are working closely with colleagues in secondary care to produce all the shared care protocols required. Our intention is for prescribers to be able to access the shared care protocols available by clicking on the relevant trust categorisation against a specific drug in the traffic light system. This is an evolving process as more shared care protocols are produced.
Glossary:
# Unlicenced drug & or indication
* Full shared care protocol no required
NFD Non formulary drug