Patients who do not turn up for appointments with their GP could be fined, under plans reportedly being drawn up to cut wastage in the NHS.

The plans are included in a Health Department document entitled Delivering the NHS Plan, according to The Sun newspaper.

The document was reportedly drawn up by Health Secretary Alan Milburn following the Budget on 17 April which gave the NHS an extra �40bn over the next five years.

It spelt out his determination to stop "unfair and inappropriate" use of NHS resources.

The right of patients to treatment when they needed it gave them an equal duty to use the health service responsibly, the document warned.

False 999 calls

The Sun reported that this would mean fines for skipping appointments, prosecutions for those who call ambulances without good cause and powers to allow doctors to refuse to treat unruly patients.

The Department of Health confirmed Mr Milburn was working on ideas to improve use of NHS resources, but dismissed reports of any specific proposals as "speculation".

A spokesman said: "While patients have the right to expect access to improving services, based on need and choice, people also have a responsibility to ensure they use health services fairly and appropriately.

"As we improve the rights and experiences of patients, so we must do more to strengthen responsibility."

Figures in Delivering the NHS Plan showed that some 12% of those dialling 999 for emergency ambulances had no injury or illness.

A further 46% did not need emergency treatment.

'Administrative nightmare'

A survey published in August last year found that patients who did not turn up for appointments with their family doctor were wasting almost �17m a year.

The Doctor Patient Partnership survey suggested that more than 2.5m hours were being lost by GPs every year as they sat waiting for non-attendees.

Dr Terry John, a GP from east London, said at the time that many doctors supported the idea of a charge.

However, he added that such a penalty would be "an administrative nightmare, and nearly impossible to police".

He added that some of the blame lay with the surgeries themselves.

"Many times patients try to call to cancel their appointments and are not able to get through on busy surgery lines."