The injustice of a postcode lottery for medical treatment must end, doctors said yesterday as they began their annual conference.

In a series of heated debates they decried the financial constraints that were affecting patient care. To a standing ovation, British Medical Association (BMA) chairman Dr Hamish Meldrum said the NHS was facing the most difficult financial situation of its 63 year history and urged health chiefs not to "slash and burn" to save money.

London GP Chaand Nagpaul said he found it "shameful" that some seriously ill patients had to consider moving home to get treatment unavailable in their area, adding there were were huge variations "entirely dictated by where they live".

His own Primary Care Trust, he explained, had a list of 85 low priority treatments. He could only refer hernia patients for operations if they were in significant pain, people with cataracts if their vision was impaired enough or those needing hip or knee replacements according to how much their mobility was affected.

"No patient should ever have to endure the injustice of having their treatment denied simply based on their post code," he said. "The criteria for these are often subjective, adding to the lottery effect." Doctors in his surgery, were trying to "find a way around" the restrictions so they could continue to refer patients strictly on clinical judgment, he explained.

"For knee and hip replacements, these are people who have significantly impaired mobility. They are elderly and it could make a difference between going to the shops or being housebound. It is hard to argue that anyone who has a clinical need for a hip replacement should be restricted," said Dr Napaul.

Surgeon, Ian McNab added that there were too many examples of patients being deemed low priority because of incorrectly interpreted evidence and a danger some could suffer permanent damage if they were not referred swiftly enough. "We must ensure that PCTs and their successors understand the consequences of their decisions and take responsibility," said Mr McNab.

Dr Nagpaul argued that, while GPs recognised that unlimited funds were not available, there should be a fair national basis for treatment thresholds, but: "It is shameful that some seriously ill patients consider moving address purely as a means to access treatment."

Opening the BMA's Annual Representative Meeting in Cardiff, Dr Meldrum said the government had made some positive changes on NHS reform - but stressed any development must not be thrown away with "short-term" cost cutting of frontline care.

"There is a huge difference between adapt and change and slash and burn, between carefully planned reorganisations and knee-jerk closures and redundancies," he said, adding that doctors had grave concerns about the revised Health and Social Care Bill.

To resounding applause, he pointed out that feelings were running high on changes to the NHS pension scheme. "We're not asking for special treatment - but we are asking for fairness based on the facts," he said, warning: “Whilst we will be reasonable, whilst we will not rush to precipitate action, whilst we will not put patients’ lives at risk, do not, in any way, or for one single moment, mistake this responsible attitude as a reason to underestimate our strength of feeling, our resolve and our determination to seek fairness for those we represent.”

A Department of Health spokesman said: "It is surprising the BMA is calling for decisions about patient care to be made centrally, and not by local health experts. We have strengthened plans that will see clinicians being able to tailor services to local needs so that patients get the care they need."