The controversial scheme covers all non-urgent referrals – including requests for hip and knee surgery, cataract removal as well as x-rays and scans.

GPs must submit each referral to a panel of doctors, who will consider whether the procedure is both necessary and cost-effective.

Any case which is deemed inappropriate will be sent back to the GP and the patient refused treatment.

The pilot has been rolled out across two health trusts in north-east England which collectively serve 300,000 patients. Managers claim the measures will ease the pressure on local hospitals while ensuring NHS resources are spent wisely.

But senior GPs say the scheme is unsafe and will lead to vital referrals being delayed or rejected. Patients sent for non-urgent scans can later be found to have cancer, heart disease or other life-threatening conditions.

The scheme – uncovered by Pulse magazine – is being introduced this month across Darlington and Hartlepool and Stockton-on-Tees Clinical Commissioning Groups.

GPs have been asked to submit all non-urgent referrals to a panel of family doctors, called the clinical assessment and peer review service.

These doctors have no knowledge of the patient and will not have access to their medical notes.

Each case will be assessed over two days before being either approved or sent back to the GP with a suggestion of other treatments. ■