Mounting pressure on GPs to cut referrals is creating a 'time bomb' by jeopardising patient safety, according to the chair of the National Association of Primary Care.

Dr James Kingsland said the way referral centres were being run, with high numbers of referrals sent back to GPs, was 'outrageous'.

He made his comments after more than 60 per cent of GPs taking part in a survey by Pulse magazine said their referrals to hospital were regularly bounced back under demand management schemes. Dr Kingsland said: 'The way demand management centres are developing is outrageous. Most are operating purely to curtail referrals as part of a frightening cost-cutting exercise.

'There's a real patient safety issue - we're sitting on a time bomb. I fear it is inevitable that at some point this year we will have a seriously ill patient who is damaged as a result of their case being managed badly.'

He pointed to evidence showing that as practices develop their expertise in particular areas, referral rates often go up. 'I accept that GPs don't always get it right,' he said. 'But that should not equate to putting a filter in place to save money.' Improved training would be a better way of helping, he said.

A Department of Health spokesperson said while patients should be referred where necessary, dealing with some referrals outside large hospitals could relieve pressure on the NHS, provide more convenient care and deliver better value.