RAG CLASSIFICATION OF DRUGS FOR PRESCRIBERS
BACKGROUND
It is important for patient care that there is a clear understanding of where clinical and prescribing responsibility rests between Secondary and Primary Care Prescribers.
The Red Amber Green (RAG) classification offers guidance on the prescribing of drugs initiated in secondary care and reinforces the basic premise that:
“When clinical and / or prescribing responsibility for a patient is transferred from secondary to primary care, the primary care prescriber should have the appropriate competence to prescribe the necessary medicines. Therefore, it is essential that a transfer of care involving medicines that a primary care prescriber would not normally be familiar with, should not take place without the sharing of information with the primary care prescriber and their mutual agreement to the transfer of care.”
These are not rigid guidelines. In all cases, secondary and primary care prescribers should discuss the appropriate management of individual patients personally. On occasions both parties may agree to work outside of this guidance.
RED Medicines: - Recommended for Secondary care prescribing only.
These treatments require specialist knowledge, monitoring, dose adjustment or further evaluation in use. If however, a primary care prescriber has particular specialist knowledge or experience of prescribing a particular drug for a particular patient it would not be appropriate for them to expect to transfer that prescribing responsibility back to secondary care.
Primary care prescribers may prescribe RED medicines in exceptional circumstances topatients to ensure continuity of supply while arrangements are made to obtain usual supplies from secondary care.
AMBER Medicines: - Initiated in secondary care, continued in primary care.
Prescribing is initiated by secondary care then following patient stabilisation, prescribing is continued in primary care with ongoing communication between secondary and primary care. NB: Some drugs may be initiated in clinics provided by a GPwSI.
Sharing of care assumes communication between the specialist, primary care prescriber and patient. It is important that patients are consulted about treatment and are in agreement with it. The intention to share care is usually explained to the patient by the prescriber initiating treatment. Patientsshould remainunder regular follow-up in secondary care, where their overall response to treatment and need for continued treatment should be monitored.
Prescribers are reminded that the doctor who prescribes the medication legally assumes clinical responsibility for the drug and the consequences of its use.
If a primary care prescriberfeels unable to undertake this role, then they are under no obligation to do so.In such an event, the total clinical responsibility for the patient for that diagnosed condition remains with the specialist.
Inherent in any shared care agreement is the understanding that participation is at the discretion of the GP subject to his clinical confidence.
AMBER SHARED CARE: - Ongoing liaison between specialist & GP
Medicines considered suitable for GP prescribing following specialist initiation of therapy, with ongoing communication between the primary care prescriber and specialist. Primary care prescribersare usually invited to participate in shared care agreements.These medicines usually require e.g. blood test monitoring, for which an enhanced service may be suitable. (Subject to local commissioning agreements)
Primary care prescribers are advised not to take on prescribing of these medicines unless they have been adequately informed by letter of their responsibilities with regards to monitoring, side effects and interactions and they are subsequently happy to take on the prescribing responsibility. A copy of locally approved guidelines or information should accompany the request which outlines these responsibilities. Primary care prescribers should then inform secondary care of their intentions as soon as possible so that arrangements can be made for the transfer of care.
GREEN Medicines: - Suitable for initiating prescribing in primary care or secondary care.
BLACK Medicines: - Not Recommended for Use
These aremedicines that have been reviewed and have been deemed less suitable for prescribing, and are therefore not recommended in primary or secondary care. This may bedue to the lack of good clinical evidence, or due to the availability of more suitable alternatives.
GREY Medicines: - Due for review
These medicines are scheduled for review either by NICE or the local prescribing forum.