netFormulary NHS
NHS Bath and North East Somerset, Swindon and Wiltshire CCG
Royal United Hospitals Bath NHS Foundation Trust
Great Western Hospitals NHS Foundation Trust
Salisbury NHS Foundation Trust
 Formulary Chapter 16: Paediatrics - Full Chapter


This chapter contains information from BCAP, Microguide and 3T's but a joint finalised version has yet to be agreed. Please use the information presented here in combination with the appropriate local guidelines.

Paediatric Drugs and the Traffic Light System

This guidance applies:

  • only where a drug does not already have a TLS classification
  • only for long-term use of a medicine where the patient would not otherwise visit the initiating clinician or unit at intervals of 60 days or less

Paediatric drugs are frequently used outside the makers Summary of Product Characteristics since many manufacturers fail to conduct the relevant trials needed to secure licensed use in paediatrics. Local guidance has made clear that the BNF for Children is the accepted reference.


Drug Indication 

In BNF-C for indication and dose range

In BNF-C but outside indications or dose range Not in BNF-C

Licensed drug within SPC indications

Amber No Shared Care Protocol (SCP) needed


Off label use of drug   (as per BNF-C definition page 2)

Amber if SCP agreed


Unlicensed drug

Amber if SCP agreed


 RCPCH and NPPG joint position statement -

16.10  Expand sub section  Blood Glucose Monitoring

NICE information on Freestyle Libre 


Following NHS England’s (NHSE) announcement of  Flash Glucose Monitoring: National arrangements for funding of relevant diabetes patients  From 1st April 2019 the local formulary groups (BCAP, 3T's Swindon, Microguide Salisbury) have agreed to amend the status of Freestyle Libre (FSL) from red to amber (specialist recommendation). There will be some central funding made available fro FSL but reimbursement to CCGs will only be based on primary care prescribing, hence the change.

Existing Patients

  • Responsibility for prescribing FSL sensors for existing patients can now be passed from secondary care to the patients GP practice
  • The ongoing review and clinical care of existing patients will be retained by Specialist Teams

New Patients

  • FSL should not be initiated by GP's in primary care
  • Specialist Teams will identify patients meeting the criteria set out by NHSE (see link above) at the patients next routine review. Specialist Teams will provide patient education, initiate a patient contract, review benefits after 6 months and provide ongoing clinical care
  • GP's should take on the prescribing of FSL sensors when asked to do so by the Specialist Teams

Patients currently self-funding Freestyle Libre

  • These patients should be assessed to see if they meet the criteria set out by NHSE (see link above) at the patients next routine review with the Specialist Teams
  • Patients should not be referred to a specialist just to assess FSL on the NHS

Freestyle Libre 
View adult BNF View SPC online
  • See information above
  • A Freestyle Libre Sensor lasts for 2 weeks, so one month’s supply is 2 sensors


note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Track Changes
Display tracking information
click to search
Link to adult BNF
click to search
Link to SPCs
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHS England
High Cost Drug Approval System

Traffic Light Status Information

Status Description


RED - Hospital only to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.  


Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.  

Amber with Shared Care

Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  


These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.  


Suitable for patient to be directed to buy themselves  


Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.   


Not currently used. We intend to include this TLS in future to highlight where a decision has been made by either or both the local or national NHS not to routinely commission this preparation for its licensed indications. Do not prescribe.  

Red Specialist Centre

Not currently used. We intend to include this TLS in future to highlight where this medicine and indication is ONLY available through a Specialist Centre according to a NICE Highly Specialised Technology or NHSE Specialised Commission Circular / Policy.