Doctors in Oxfordshire are reportedly being offered payments in a bid to cut the number of patients they send to specialists and consultants.
Oxfordshire NHS Primary Care Trust could hand up to £1.2m to GPs in incentives as it faces a possible overspend of up to £23m, the Oxford Mail reported.
The trust said the new scheme would help save millions of pounds as a leap in the number of referrals is blamed for £6m of the overspend.
However, patient groups have expressed fears the money could influence clinical decisions and have questioned why GPs should get extra money for making medical judgements.
The trust said it was trying to establish the reason for a rise in referrals but one cause may be the success of the John Radcliffe Hospital and Nuffield Orthopaedic Centre (NOC) in cutting waiting times.
Sue Woollacott, of the NOC's Patient Support Group, told the Oxford Mail: "Patient referrals should always be based on clinical need.
"If such a payment of money were to directly or indirectly affect GP judgment about the clinical need of a patients it would be appalling. I cannot see why the PCT thinks GPs need incentives to make good clinical judgements."
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