A leading teaching hospital has been accused of breaking the rules around patient choice by closing its doors to routine referrals for patients outside its area.

University Hospitals Birmingham Foundation Trust chief executive Dame Julie Moore has written to GPs and commissioners across the West Midlands, informing them the trust will not accept new GP referrals for secondary care work that could be done by neighbouring providers.

The directive covers referrals for dermatology, pain management, urology and general surgery.

In mid October the restriction will be extended to ear nose and throat services.

GPs and clinical commissioning groups in Solihull, Herefordshire, the Black Country, Warwickshire, Worcestershire and Coventry have all received letters.

A trust spokeswoman said it had so far turned away 173 referrals, with Sandwell and West Birmingham, and Redditch and Bromsgrove CCGs the most affected.

The trust’s internal legal advisers have pointed out that providing choice to patients was the responsibility of commissioners, not the trust, and other providers were still available to affected CCGs.

She said the trust was contractually required to treat patients within 18 weeks of referral, but that demand was growing “unchecked”.

Closing the doors of its Queen Elizabeth Hospital to out of area patients would safeguard the trust’s ability to hit the 18 weeks target for its local population.

Dame Julie argued that rising demand for elective secondary care was also squeezing the trust’s ability to provide tertiary care for patients.

“If we’re doing the smaller secondary care [procedures], we’re not doing the tertiary stuff,” she said.

“Loads of people can do the little stuff - there are local hospitals to do it. But we’re the only ones doing liver cancers and complex cardiac stuff and they have to come to us.”

However, Jonathan Wells, chair of Redditch and Bromsgrove CCG, told HSJ: “We’re not happy about it at all. We think it is definitely against the rules.

“It is particularly difficult for us in Redditch and Bromsgrove, as our patients tend to look north rather than south due to the much better public transport links… but in any case it goes against patient choice.”

He added: “The Queen Elizabeth is not the only hospital struggling on referral to treatment [waiting times]… what would we do if more providers closed their doors in this way?”

In 2014-15 so far, 22 per cent of outpatient activity across those five specialties has come from ‘out of area’ patients, up from 20 per cent for the same period last year and compared with 17 per cent in 2012-13.