Doctors in Oxfordshire are being offered payments to try to reduce the number of patients they send to specialists and consultants.

Up to £1.2m will be handed to GPs in incentives as Oxfordshire NHS Primary Care Trust faces a possible overspend of up to £23m, with a big rise in referrals blamed for the problem.

It said the new scheme would help save the trust millions of pounds and avoid many patients having to go to hospital, but patient groups have expressed fears the money could influence clinical decisions.

And they are questioning why well-paid GPs should get extra funding for making medical judgements.

The trust said it was still trying to establish why referrals had increased recently.

One cause is the success of the John Radcliffe Hospital and the Nuffield Orthopaedic Centre in cutting waiting times.

The county's ageing population is also viewed as a factor.

The PCT said the incentive scheme would reward doctors who could bring down referrals to the lower levels seen in 2007.

Sue Woollacott, of the NOC's Patient Support Group, said: "Patient referrals should always be based on clinical need.

"If such a payment of money were to directly or indirectly affect GP judgment about the clinical need of a patients it would be appalling.

"I cannot see why the PCT thinks GPs need incentives to make good clinical judge- ments."

A PCT document passed to the Oxford Mail said: "Analysis has shown that there has been a statistically significant increase in GP referrals and this is contributing to approximately £6m of a predicted £23m year-end overspend position."

Alan Webb, the PCT's director of commissioning, said: "What we are trying to do is understand what is driving the increase in referrals.

"What we are doing with this additional incentive scheme is asking GPs to review referral activity and processes with colleagues, which will take time. We are not paying them not to refer."

The trust said it was confident the scheme would ultimately save money. The alternative would be to cut other elements of the PCT budget such as health promotion and drugs.

Oxfordshire Local Medical Committee, representing more than 300 GPs in the county, has backed the scheme, which started last week.

Its chairman Dr Rickman Godlee said: "The number of referrals has increased dramatically. Hospitals are paid for the amount of work they do.

"The scheme is a good idea. Referrals to hospitals are expensive, costing between £150 and £200 for each patient."