Prescribing Traffic Light Classification
We receive many queries regarding the prescribing of medication. The landscape for this is getting more complicated and we will be drawing together more detailed guidance. In the meantime below is a summary:
ICB Formulary categorises new drugs as :-
Green | GP initiation, titration & prescribing |
Green Advice | Specialist advice and GP initiate, titrate, prescribe |
Green Advice | Specialist initiate, titrate, stabilise then GP prescribe – the patient does not necessarily stay under the care of the specialist. |
Amber (4 levels) | Specialist initiate, titrate, stabilise then GP prescribe – with ongoing support of Specialist under the terms of a shared care agreement (there are 4 levels of monitoring). |
Red | Hospital only. Not to be prescribed in general practice |
Black | Not commissioned, should not be used |
The key thing to remember is just because a drug is green or amber this does not mean the GP HAS to take over prescribing, only that they CAN.
The GMS contract requires practices to provide services “in the manner determined by the Contractor’s practice in discussion with the patient.” Advice from a specalist will form part of making that determination, but the decision sits with the GP/Prescriber.
The contract also states, “make available such treatment or further investigations as is necessary” and appropriate for the patient (Clause 8.1.3(b)). This would normally include prescribing repeat items as needed for their conditions. Therefore, if you are asking that the specialist continues to do provide the prescription for the patient you should explain why.
Whoever signs a prescription is liable for it and clinically responsible. Therefore, they need to be comfortable that they have all of the information needed to inform that decision, and are familiar enough with the drug to be competent to know it is appropriate for that patient.
Although most requests will be entirely appropriate and you will feel confident in your prescribing, please bear in mind that:-
- If you do not feel confident and/or competent … you should not be prescribing.
- If you do not feel you have been given enough information to understand why you are being advised to prescribe … you should not be prescribing.
- If you do not feel the patient has been appropriately assessed or they are not getting the required monitoring or follow-up ….. you should not be prescribing.
- If you do not feel the provider who is advising you is a safe provider, or if the request has not come from a named individual registered healthcare professional … you should not be prescribing.
If a GP is unsure if they should have been asked to prescribe – check
Not all requests will be appropriate, there are many different factors. It is also very difficult to give generic advice because many of the considerations will be patient specific. We are always happy to look into issues when they arise.
We have provided a template letter to assist practices in responding to providers where they are unable to fulfil requests to prescribe.
Where you feel the provider is also breaching their contract please also utilise the PID process
