The NHS Atlas of Variation further highlights the pressure on the NHS to restrict access to some services and medicines.

The publication says unwarranted variations in activity and spending “indicate the need to focus on appropriateness of the clinical service, and to investigate the possibilities that there is overuse of some technologies, with some lower value activities being undertaken”.

It suggests, for example, that some knee replacements are of limited value to patients with mild symptoms. GP Steven Laitner, the newly appointed national clinical lead for shared decision making, said using decision aids could reduce over- and underprovision of this and other treatments. However, the atlas warns against “arbitrary” treatment thresholds.

The atlas’s advice comes as primary care trusts try to limit referrals for some procedures. Last month NHS Warwickshire implemented strict controls for routine elective orthopaedic operations and cataract surgery.

Addressing the two-fold variation in cataract surgery, the atlas says the NHS may now be “overservicing” after a steep rise since 1989. It says the NHS should consider the cost, not only with respect to the benefit for people waiting for cataracts, but also with respect to the opportunity costs that would be derived from investing in other treatments for eye conditions.

Philip DaSilva, one of the DH QIPP leads who co-wrote the foreword to the atlas, said: “We need to get into a mindset of asking how we allocate resources in a transparent way.

“[So far] there is no huge debate about how to allocate resources between new technologies and caring for existing diseases.”

However, the guidance also comes amid reports that the National Institute for Health and Clinical Excellence is to lose the ability to restrict use of low value drugs and technologies.

Mr DaSilva said clinical commissioners would make allocation decisions in the future but would need more “space and time” to learn about resource implications.