LOCAL GPs are under pressure to contribute to health savings by curbing spending on prescriptions and cutting patient referrals to hospital.

A health trust warns that money is being wasted through doctors prescribing patients top-of-the-range drugs from leading companies.

With the local health health service faced with a £1.3m overspend on prescriptions, GPs are being urged to look at cheaper alternatives.

The Oxford Primary Care Trust has also revealed that it has begun targeting the biggest overspending GP practices, to help them change their costly drug prescribing habits.

The county's primary care trusts, which will merge at the end of the month, must save £18m by next March. A report to the PCTs sets out areas of overspending still causing concern.

It says: "Prescribing is overspent by £1.3m, although the overspending trend has reduced considerably in the last month.

"We have earmarked over £3m of savings. Key to our success is changing prescribing habits to use more cost-effective generics over branded preparations."

It goes on to say that the costs of one drug, for example, varied from £40 to £15. "We have already started using this information to target those practices which are spending most on prescribing and agreeing specific action plans to reduce costs."

A spokesperson for Oxfordshire PCTs said: "This is not about preventing GPs from prescribing drugs appropriately for their patients. It is about asking GPs to be aware of the cost differences between branded and non-branded drugs and to consider this when prescribing."

One GP said: "None of us prescribe things that we do not think are effective or appropriate. But the big difference between branded and generic drugs is price. You can get the same drug, and if it is generic, it will be a tenth of the price."

Another doctor said: "The problem is that in Oxfordshire, we have a lot of dispensing practices, who buy drugs in and are reimbursed for them. They act as chemists and prescribe what they have bought. It is an income generator for them."

At the same time, doctors are also being pressed to make more savings, by further reducing the numbers of patients referred to consultants and hospital out-patients. The trust has also warned GPs that it would compare referral rates across Oxfordshire.

The issue of GP referrals has become an increasingly contentious one, since the creation of the Clinical Advisory Liaison Services to review GP referrals.

Banbury MP Tony Baldry described the system as a "Stalinist process" which involved second guessing and vetting referral letters from GPs, causing delays and leaving outpatient clinics half empty.

But the new report on the trust's recovery programme says that CALS has been effective in bringing down referrals. Specialities found to be overspending by more than five per cent include breast surgery, cardiology, trauma and orthopaedics.

Oxford GP Helen Groome said: "Because GPs do not have the same skills and specialisms, referral levels will vary. What would be wrong is if doctors are asked to reduce referrals when they were appropriate for patients."