Traffic Light List of Medicines

 Leeds Health Economy Traffic Light Classifications

The NHS in Leeds uses a traffic light system for the classification of medicines.  This has recently been reviewed and currently drugs are classified as Green, Amber, Red, Grey or Black Light. The definitions of these classifications are outlined below. 

The GP would generally be considered as the patient’s primary physician.  When a specialist initiates a medicine, they will generally diagnose and recommend/initiate treatment, with the aim of returning care of the patient to the GP where appropriate (unless the drug is classified as red, see below).  It is safer to have one main prescriber for a patient than to have multiple prescribers from different specialities. It is also safer to have someone who holds in entirety a complete list of drugs that each patient is being prescribed (prescribed by both the GP and hospital NB the GP must also document red drugs prescribed to a patient, even though they are not prescribed by the GP). Obviously the best interests of the individual patient must be considered.

The Red, Amber, Grey and Black Light Drugs are given on the Traffic Light list.

Green Drugs

• Appropriate for initiation and ongoing prescribing by GPs and hospital prescribers
• Generally little or no routine drug monitoring required
• Due to the extensive number of Green Drugs they are not listed on the Traffic Light list.

Amber Drugs   

These are medicines which are recommended or initiated by a specialist, but can then be prescribed by GPs. Amber Drugs are split into three further categories:

• Amber level 1 - Specialist recommendation
• Amber level 2 - Specialist initiation
• Amber level 3 - Specialist initiation with ongoing monitoring requirements.

Amber Level 1- Specialist Recommendation

Medicines recommended by a specialist, which could offer a valuable alternative/addition to the patients’ treatment.  These medicines are considered suitable for GP prescribing following specialist recommendation.  Little or no monitoring is required.  A brief prescribing guidance document will be available for these drugs, but there is no requirement for full amber drug guidance.  All patients on Amber Level 1 drugs should still be regularly reviewed by their GP regarding their Amber Drug treatment.  

Amber Level 2- Specialist Initiation but no monitoring requirements

Medicines initiated by a specialist where there is not a need for ongoing monitoring other than for general adverse effects.  These medicines are considered suitable for GP prescribing following specialist initiation, including titration of dose and assessment of efficacy.  The hospital specialist will highlight if there is any need for further monitoring as part of an ongoing review.  All patients on Amber Level 2 drugs should still be regularly reviewed by their GP regarding their Amber Drug treatment.   A brief prescribing guidance document will be available for these drugs, but there is no requirement for full Amber Drug Guidance. 

Amber Level 3- Specialist Initiation with ongoing monitoring requirements (Full Amber Drug Guidance required)

Medicines that should be initiated by a specialist, and which require significant monitoring on an ongoing basis.  After a successful initiation period, a transition to GP care can take place.  Full agreement to share the care of each specific patient must be reached under the amber drug agreement, and amber drug guidance must be provided to the GP (available on LHP).  The amber drug guidance will outline the specialist and GP responsibilities (including monitoring requirements) and basic prescribing information. 

The GP has the responsibility to ensure they have sufficient information to safely prescribe any amber drug.  If they feel that the amber drug guidance/prescribing guidance and clinic letter are not sufficient they should contact the specialist to resolve any concerns they might have.

Red Drugs

Medicines for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician. The drug should be supplied by the hospital for the duration of the treatment course.  Primary care prescriber initiation or continuation of treatment is not recommended.

Specialist prescribers (e.g. GPwSI or Community Paediatrician) working in the primary care setting are able to initiate Red Drugs providing they have the necessary expertise, that they prescribe the medicines on an ongoing basis and that an appropriate supply can be sourced.

To minimise the risk to the patient the GP must be informed in writing that a Red Drug has been started. This is so the GP has a complete picture of the patient’s medicines and not for the purpose of supply.

In exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to prescribe a Red Drug. This must be agreed on an individual patient basis with the role of the specialist and the GP clearly defined and documented.  This should only happen when the GP is willing and able to take clinical responsibility for the prescribing of the red drug, and following full assessments of risks and benefits. 

The Red Drugs are given on the Traffic Light List. 

Grey Drugs

Grey Drugs are locally-agreed medicines which are only recommended for restricted use within the Leeds Health Economy. Grey drugs may be recommended for specific indications but not others.  The Grey List is intended to support good prescribing and help prescribers make balanced decisions. Grey Drugs should only be prescribed in exceptional circumstances. The Grey List outlines circumstances in which exceptional prescribing might be appropriate. Occasionally the use of a Grey Drug may be in a particular patient’s best interests. The Grey List applies to the Leeds health trusts and to GP practices. Inclusion of drugs on the Grey List should encourage prescribers to think very carefully before prescribing or recommending the medicine.

The Grey Drugs are given on the Traffic Light List.

Black Light Drugs

These drugs are not recommended for use within the Leeds health economy and this decision has been supported by Leeds Area Prescribing Committee.  All new drugs will be assumed Black Light until they have been through the appropriate approval process.

The Black Light Drugs are given on the Traffic Light List.

Criteria for classification

1. Lack of data on efficacy.
2. Lack of safety data.
3. Greater risk of significant adverse events compared to standard/existing therapy.
4. Lack of cost-effectiveness data.
5. Less cost-effective than existing therapy.
6. Not supported by Leeds Teaching Hospital Drug and Therapeutics Committee; Leeds Partnership Foundation Trust Drug and Therapeutics Committee; or NHS Leeds.
7. NICE/SMC do not recommend.
8. Not recommended by Yorkshire and Humber Specialised Commissioning Group.

Related downloads

Leeds Health Economy Traffic Light Classifications for prescribers.doc (0.40 MB)

| Leeds Health Economy Traffic Light Classification poster.pdf (0.18 MB)

| Traffic light drugs classification - patient information leaflet.pdf (0.20 MB)

| Traffic light drugs classification - basic guide for patients.pdf (0.13 MB)

Shared Management of Medicines Project Information for Prescribers.doc (0.12 MB)

The Net Formulary info for prescribers.doc (0.17 MB)