STRICT controls over which patients are referred to hospital could be in place for all procedures by the end of September.

Selby and York Primary Care Trust's (PCT) board yesterday approved an ambitious financial recovery plan which contains details of how it proposes to cut nearly £23million from health spending this year.

Part of the cost-cutting plans include a referrals system which screens patients for some treatments, like orthopaedic procedures.

Under the system, patients can be sent back to GPs, or dealt with in other ways, if they do not meet the required criteria for hospital treatment.

Rachel Potts, the trust's associate director of performance and commissioning, told board members that the trust aimed to roll this system out across all specialities by the end of September.

The move could worry GPs who have strongly criticised the scheme.

Dr David Hartley, chairman of York Health Group, said: "If they roll it out in the form in which it stands at the moment we obviously continue to be very unhappy with it because we don't see it as sound clinical advice."

Earlier this month we reported how Diane Clark from Huntington had already been refused treatment for her a painful lump in her wrist after her hospital referral by her GP was rejected.

The PCT has said it intends to recruit more medics to be involved in referral decisions.

The trust has a legal obligation to save £22.8million by April 2007, but its financial recovery plan has so far only got firm proposals for cutting £15million and bosses are still working on the remainder.

Acting chief executive Penny Jones said at yesterday's meeting: "I think it's a good plan, a lot of people have had a say on it.

"We have still got an awful lot to do in terms of getting support from people living in the patch and working in the patch.

"We recognise it would be a lot less risky if we had a two year period not withstanding that we feel it's an achievable plan.

"The aim is that we don't have a detrimental impact on the standards and quality of care that's incredibly challenging.

"You can't take this level of savings out without having some impact. We have got to focus the money on those who need it the most."

Janet Probert, director of nursing at Craven, Harrogate and Rural District PCT, said: "The real challenge is to ensure that we never go below the line that's clinically safe."