By Nick Triggle
BBC News at the BMA conference, Belfast
Patient care is being compromised by systems being put in place to manage GP referrals for surgery, say doctors.
Indepenent sector treatment centres are taking on NHS work
Local health bosses are setting up management referral centres - some staffed by non-clinical staff - to decide where patients are sent.
But doctors said some being being sent to private clinics where inappropriate decisions were being made.
One woman in her 50s was told she needed a knee replacement when her GP said only minor surgery was required.
Up to 40 management referrals centres have been set up by primary care trusts in England.
They have been designed to channel patients referred for treatment by GPs to the most appropriate services.
This could include hospitals, independent sector treatment centres - private clinics which have been set up to carry out minor surgery for the NHS - or community-based therapies such as physiotherapy.
Pushed to treatment centre
But Charlie Daniels, a GP from Torquay, said his local referral centre was pressurising patients specifically to use an independent sector treatment centre about 35 miles from his surgery.
He said: "My patients are in favour of choice, they want to choose their local hospital, but are being prevented from going there by the referral centre.
Dr Daniels said patients were often vulnerable
"I refer them for hospital treatment, but it goes to the referral centre which has written to patients saying would they like to go to this brand-spanking new independent sector treatment centre where there are no waits.
"These are vulnerable patients and sometimes what is being suggested is wrong.
"I have heard of a case where a middle-aged woman was told she needed a full knee replacement by the independent sector treatment centre when that was totally inappropriate for her."
Dr Daniels said doctors were frustrated that while they agreed in principle with some of the government reforms, many were simply not working in practice.
BMA chairman James Johnson said: "The point is that the GP is the best person to be referring the patients.
"Staff at these referral centres have not seen the patient and are not in the best position to judge.
"It also raises concerns about the independent sector treatment centres. We do not know about the standards of care there at all."
A spokeswoman for the Department of Health said surveys showed patients were satisfied with the care they received in independent sector treatment centres.
She added: "We heard a range of accusations about treatment centres even before any of them opened, and we are still waiting for any firm evidence to support them.
"Patient safety is always our top priority in all of the department's contracts with the independent sector and all treatment centres are thoroughly
audited and inspected."