Quick Decision Guide
Please see the Rotherham LMC flowchart.
Traffic light status describes commissioning arrangements—it does not oblige an individual GP to prescribe. Every prescriber remains responsible for ensuring they are competent, appropriately supported and able to prescribe safely in accordance with GMC guidance.
Introduction
Prescribing in primary care is increasingly complex. Many medicines are initiated by specialists or community services, and GPs are frequently asked to continue prescribing. This guide supports primary care clinicians to make safe, consistent prescribing decisions and clarifies local prescribing responsibilities. Use this guide whenever you receive a request to prescribe:
- a medicine you are unfamiliar with;
- a medicine initiated outside primary care; or
- a medicine that falls outside your usual prescribing practice.
This guide complements, but does not replace, your professional responsibilities under GMC Good Medical Practice and Good Practice in Prescribing and Managing Medicines and Devices.
Safe Prescribing Pathway
Step 1 – Check the Rotherham Traffic Light System (RTLS)
Access the RTLS via: https://yourhealthrotherham.co.uk/traffic-light/
The traffic light status indicates prescribing responsibility.
|
Status |
Meaning |
|
Green |
Suitable for initiation and prescribing in primary care. |
|
Amber-G |
Specialist initiates treatment. Primary care may continue prescribing without ongoing specialist oversight. |
|
Amber |
Shared care medicine. Specialist initiates treatment and retains responsibility for specialist advice. Primary care may choose to prescribe under shared care arrangements. |
|
Red |
Specialist prescribing only. |
|
Grey |
Not recommended for prescribing in primary care. |
Step 2 – If the medicine is RED or GREY
Do not prescribe.
Respond to the requesting clinician using the Red Drug Template Letter.
No further action is required unless patient safety requires interim arrangements.
Step 3 – If the medicine is AMBER or AMBER-G
Prescribing Amber medicines is not mandatory.
Before accepting prescribing responsibility, ask yourself:
Competence
- Do I have sufficient knowledge and experience to prescribe this medicine safely?
- Am I familiar with the monitoring requirements?
Practice systems
- Does the practice have safe systems to provide the required monitoring?
- Can results be acted upon promptly?
- Is responsibility for monitoring and prescribing clearly understood within the practice?
- Does the practice have sufficient clinical and administrative capacity to safely absorb the additional workload associated with prescribing, monitoring, patient recalls, reviewing results and responding to abnormal findings?
- Has the required Shared Care Agreement for all Amber drugs been received from the initiating NHS specialist? (If the practice agrees to accept shared care, the agreement should be signed by the practice and returned to the specialist before prescribing responsibility is accepted.)
Funding
Check whether the medicine is included within a funded Rotherham Shared Care Agreement (Appendix 3).
If it is:
- ensure your practice has appropriate monitoring systems in place
- ensure the Local Enhanced Service (LES) requirements are met
- ensure the appropriate LES payments are claimed.
Decision
If the answer to all of the above is Yes, you may accept prescribing responsibility.
If the answer to any is No, you are under no obligation to prescribe.
Use the appropriate Amber Response Template Letter to decline prescribing.
Practices should only accept prescribing responsibility where they have the necessary clinical expertise, governance arrangements, staffing capacity and monitoring systems to do so safely. Where a formal Shared Care Agreement is required, prescribing responsibility should not transfer until the agreement has been completed and signed by both secondary and primary care.
Step 4 – If the medicine is NOT on the RTLS
A medicine absent from RTLS may be:
- an established Green medicine;
- a medicine recently classified by IMOC but not yet incorporated into RTLS;
- a newly licensed medicine awaiting local review.
Before prescribing:
- Check the appendices to this guide.
- Discuss with experienced colleagues if unfamiliar.
- If still uncertain, contact the Medicines Optimisation Team:
syicb-sheffield.syicb.medsopt1@nhs.net
If you remain unfamiliar with the medicine, or believe you cannot prescribe it safely within your competence or practice systems, use the Template Bounce Letter.
Professional Responsibilities
Regardless of traffic light status, every prescriber remains professionally responsible for their own prescribing decisions.
You should only prescribe when you are satisfied that:
- you have sufficient knowledge of the medicine;
- you understand the monitoring requirements;
- appropriate systems are in place;
- prescribing is within your competence; and
- prescribing is safe for the individual patient.
Traffic light status supports decision-making but does not override your professional judgement
Appendices
Appendix 1 – Rotherham LMC “White List” (AKA a list of familiar Green drugs)
Medicines reviewed by Rotherham LMC and considered sufficiently familiar that the average GP would be expected to prescribe them routinely.
These medicines are generally prescribed at least five times per year by the average GP.
Under GMC guidance, clinicians are expected to maintain competence in prescribing these medicines.
(See Rotherham LMC ‘White List’.)
Appendix 2 – IMOC Traffic Light Changes
Medicines where IMOC has proposed a change in traffic light status and Rotherham LMC has raised concerns or formally challenged the proposed classification.
LMC would support practices who declined prescribing these drugs
(See Rotherham IMOC spreadsheet.)
Appendix 3 – Funded Shared Care Medicines
Current medicines included within funded Rotherham Shared Care Agreements.
Practices accepting responsibility for these medicines should ensure:
- appropriate monitoring systems are in place;
- LES requirements are met; and
- claims are submitted correctly.
Current funded medicines (2026/27) include:
- Methotrexate
- Leflunomide
- Sulfasalazine
- Azathioprine
- Mycophenolate
- Mercaptopurine (6-MP)
- Denosumab
- Ibandronic acid
- Testosterone
Additional funded LES schemes include:
Anticoagulation LES
- Warfarin
Dementia LES
- Donepezil
- Rivastigmine
- Memantine
Shared Care Matrix:
https://yourhealthrotherham.co.uk/download/shared-care-protocols-matrix/
LES Specification:
https://www.rotherhamlmc.org/guidance
Practices can decline to prescribe new funded shared care medications to support the principles of collective action. (See July 2026 BMA Action on Shared Care)
Appendix 4 – Barnsley Shared Care List
Barnsley commissions prescribing of a wider range of shared care medicines than Rotherham.
These medicines are categorised according to monitoring requirements (high, intermediate and low).
Some medicines:
- are already funded in Rotherham ( see step 3.);
- remain Red under the Rotherham Traffic Light System ( see step 2);
- are considered suitable for primary care prescribing but are currently unfunded ( we suggest in accordance with collective action that you decline to prescribe these).
(See Barnsley LES list.)