A spokesman for North Yorkshire and York PCT said today: "The prior approval measures introduced by North Yorkshire and York PCT are not unprecedented in the NHS and are also being used in various other parts of the country.

We recognise they have caused some concern with local GPs but we are convinced they are essential in view of the severe overspend the local health community is facing.

Every referral a GP makes has a financial consequence on the PCT budget and with a predicted end-of-year deficit of £45 million, this means we are currently spending money we simply do not have.

"With that fact in mind, we do not believe it is unreasonable that we have put in place clear referral guidelines as well as measures whereby non-urgent referrals are assessed by doctors working for the PCT.

These allow us to continue to maintain waiting time targets and provide access to urgent care as normal and will make an important contribution towards starting to address the situation.

As well as our responsibility to look after the health of local people, which we fully acknowledge, there is no getting away from the fact that the PCT has a duty to the taxpayer to ensure local health services are delivered within a set budget.

The PCT first revealed its proposals to a group of GP representatives at a meeting in Easingwold on December 19 and since then there has been ongoing discussion.

"A number of modifications were made as a result of comments received by the PCT prior to the board meeting on January 9. We made clear at the outset that the deteriorating financial situation meant that the timescale for implementation of these urgent measures was short but we would take seriously any comments received.

"Separately, the PCT is also working on a longer-term financial recovery plan and this will be the subject of separate and more detailed engagement once it has been published in draft form.

"The PCT acknowledges that there is and has always been a matter of clinical judgement for GPs in the case of patients with unclear symptoms of whatever nature. If there is any suspicion of cancer, urgent referrals can continue to be made as normal, and in other cases the PCT has committed itself to turning round requests for prior approval in a timely way.

"We take responsibility for ensuring procedures we have put in place are safe for patients."