Tighter controls planned on how doctors prescribe

Tighter controls on the way doctors treat patients, which would require them to follow "recipes" for different conditions, are being considered by ministers to help the NHS meet the growing demands on its services.

Tighter controls on the way doctors treat patients, which would require them to follow "recipes" for different conditions, are being considered by ministers to help the NHS meet the growing demands on its services.

Instead of rationing access to care by waiting lists - the traditional method - ministers believe that giving doctors detailed guidelines is the way to ensure patients get the best care within limited resources. Doctors who agree to follow the guidelines could be offered financial rewards, such as investment in their hospital department or GP practice.

But the new approach was criticised yesterday as "rationing by threshold". Instead of making patients wait for their operations in a queue they will qualify for treatment only if their condition is judged serious enough to be worth treating.

The British Medical Association said it marked the introduction of "cookbook medicine". Dr Ian Bogle, the BMA chairman, said: "You look up the recipe and follow the instructions. It is stripping the art out of medicine, dehumanising the service and demotivating the staff. A certain number of guidelines are a help but rigid protocols that must be followed ignore the fact that human beings react differently."

The first example of the new guidelines are those on cancer referrals being provided to GPs. From April, all women referred by a GP with suspected cancer must be seen within two weeks, but to allay the fears of cancer specialists that the service could be overwhelmed, Professor Michael Richards, the Government's "cancer tsar", has devised a set of criteria to help GPs choose which cases should be referred urgently.

For another condition, cataracts of the eye - which cause blindness - guidelines have been developed to enable GPs to refer patients directly for surgery without the need for them to see a consultant first.

A Whitehall source said: "We want to see a more protocoldriven NHS. It is inevitable with the growth of evidence-based medicine. In cancer we have only got guidelines for the GP referral stage but eventually we want to develop them for every stage of care."

The direction of ministerial thinking is backed by a report from the Kings Fund, the health policy think-tank, published yesterday which says that the NHS's only hope of survival is to improve its control over the demands on the system. It suggests symptoms of heart disease that would justify coronary bypass surgery could be spelt out in national criteria, which would mean fewer treatments offered to the less sick but a more equitable distribution of resources. "Making criteria explicit in this way could mean that professional thresholds of care vary less throughout the NHS," it says.

Some doctors fear the move will erode their clinical freedom transforming them into technicians. But ministers see increased use of guidelines as an answer to the demand for closer controls on doctors, and as a way to assess doctors' care against uniform standards. The National Institute of Clinical Excellence (Nice) set up by the Government last year is already developing guidelines on the use of expensive drugs and common treatments, such as the removal of wisdom teeth.

Dr Liam Fox, the Tory health spokesman, said: "Guidelines are always acceptable as long as they are guidelines, but not when they are prescriptive. Medicine needs to be run according to the needs of patients and not the imperatives of politicians."