A health authority is to become the first to penalise smokers by taking them off waiting lists for surgery.

Health chiefs have taken the radical step because they say operating on smokers is more expensive.

Smokers are being ordered to try to quit their habit before surgery or risk losing the chance of an operation as Norfolk's health chiefs introduce radical steps to save money.

Norfolk Primary Care Trust, which is £50m in the red, said smokers were being targeted because they are at increased risk of complications and take more time to recover from surgery. This means they have longer - and more expensive - stays in hospital.

The new regulations, approved by Norfolk PCT, cover non-urgent operations such as hip and knee replacements or hernia operations. They stress smokers needing urgent surgery will not be affected.

But smokers complained they were being unfairly picked on, while GPs also said it was "inappropriate".

Norfolk PCT's new director of public health Dr John Battersby said: "There is increasing evidence that smokers have three times the number of complications as non-smokers. We are proposing is that if someone who smokes is being referred for surgery, we would instead want them to be referred to a smoking cessation clinic and give them three months to stop smoking.

Complications smokers are vulnerable to after surgery include wounds taking longer to heal - leading to a greater risk of developing infection, particularly chest infections - and blood clots. And for those needing vascular surgery the risks of arterial clogging are greater for someone who smokes.

"Some people will have stopped, and go on and have a referral for surgery. Others will not have stopped."

In those cases, decisions would be taken in respect of clinical need.

But not all doctors approve of the plan. Simon Lockett, secretary of the Norfolk Local Medical Committee representing GPs, said they had not been consulted by the PCT adding: "Clearly the PCT believes it has got to act as quickly as possible because of its financial position. But I think GPs would be very concerned about this idea."