HEALTH bosses are preparing their response to another stinging attack from doctors in the multi-million pound cost cuts row.

The North Yorkshire and York Local Medical Committee (LMC) has written again to North Yorkshire and York Primary Care Trust (PCT) over the introduction of measures designed to save cash.

These include suspending a wide range of procedures, including IVF; epidurals for back pain; lumbar spine x-rays, joint injections; vasectomies and removal of non-malignant skin lesions.

A PCT "prior approval" panel will vet patients referred by doctors to hospital for certain operations.

The committee has already written once to the PCT objecting strongly to the proposals and saying medics on this panel could find themselves being sued by patients.

Now Dr Douglas Moederle-Lumb, a Scarborough GP and the deputy medical secretary of the LMC, has written to the PCT's chief executive, Janet Soo-Chung, with a list of 32 questions about its measures.

The letter asked how the PCT could justify the severe impact on patients which he said would result from many of its decisions, including denying pain-relieving injections, vasectomies and treatment for grommets to all but patients whose cases were deemed "exceptional".

"GPs have a responsibility to refer patients for appropriate treatment in secondary care," he wrote.

"The PCT is suggesting that they be referred directly to an exceptions panel. This does not satisfy GPs' terms and conditions of service and I would like the PCT to justify its request to GPs that they act without their professional and ethical responsibilities."

The letter also pointed out that some cuts to service could be dangerous to patients, including the decision not to remove non-malignant skin lesions.

Dr Moederle-Lumb said lesions which seemed innocent could often turn out to be malignant on inspection, and asked how the PCT could justify this risk.

He also asked how it would justify the pain and disability for patients who would be denied treatment for varicose veins, palmar fasciectomy for Dupytren's Disease, carpal tunnel procedures and bunion surgery.

Not performing female sterilisation and vasectomies would bring social consequences and financial costs because of unwanted pregnancies, he wrote.

"IVF is to be excluded. How does this sit with the human rights of individuals to have a family?" he said elsewhere in the letter.

A spokesman from the PCT said the organisation would be responding directly to the medical committee.

The trust was continuing to talk to GPs and hospitals about its decisions and welcomed their comments.

He said there was no outright ban on any procedure, and the measures it had introduced were not about denying treatment to those who urgently needed it.