A scheme which pays bonuses to GPs for not referring patients to hospital was branded "absolutely ridiculous" by a patient group today.
The policy introduced by Oxfordshire Primary Care Trust (PCT) will see average-sized doctors' practices earning up to £20,000 for reviewing and reducing their referral rate.
If doctors hit their targets then the PCT will be left with a bill of £1.2 million. But they believe the expense is justified because the increasing amount of patients being sent to hospital is estimated to cost £6 million.
The annual number of patients referred to Oxford Radcliffe Hospital NHS Trust and Nuffield Orthopaedic Centre NHS Trust is up by 8%.
Surgeries with 10,000 patients will receive £10,000 to look at their referral procedures, and up to £10,000 more for reducing their rates.
Sue Woollacott, chairman of the Patient Support Group at Nuffield Orthopaedic Centre, said: "I think it's absolutely ridiculous. It seems to imply that GPs aren't presently making good judgments and need financial incentives in order to do that.
"If I were a GP and getting payments for the practice it would seem like some sort of bribe to me.
"To delay patients, who are often elderly, who need good orthopaedic care, and to delay them from getting necessary care can often complicate the procedures that they then eventually have to have."
A spokeswoman for Oxfordshire PCT said: "We have got significantly increasing rates of referral into secondary care providers.
"We're not sure why, so we're trying to understand why.
"We're asking them to look at the referrals they're making. That will take clinical time to do that. We're offering to pay for the time it will take them to review the referrals they're doing."
She added that surgeries would receive a further bonus if they then cut their referral rates: "They have all been set targets based on what they've done on previous years.
"What they're being asked to do is look at the referrals they're making. It's a case of them looking at each one and making sure that is the place for them to be referred to.
"The payment is for the time it takes to do the review and a bonus if they manage to bring the referral rates down."
A spokeswoman for the British Medical Association said: "Referral schemes can in many cases enhance patient care by introducing procedures whereby individual GPs can discuss non-urgent referrals with their colleagues.
"When implemented properly, they allow doctors to share knowledge and find better ways to treat their patients by, for example, referring a patient to a GP who specialises in a particular condition or to a local service that provides care on manageable conditions such as diabetes.
"This can help a patient receive efficient, close by care in their community and has the potential to reduce pressure on hospital services.
"It is important that referral schemes are introduced only after full consultation with local clinicians and that they have clear, transparent guidelines of operation.
"Schemes that include targets based on reducing referral rates should be avoided as GPs should make referral decisions based on clinical factors."
Eighty out of 82 Oxfordshire practices have signed up to the scheme, which was introduced on October 1.