A survey of almost 3,000 doctors by Doctor and Hospital Doctor newspapers found that one in five doctors know patients who have suffered harm as a result of rationing.

Noel O'Reilly from Doctor magazine: "People are dying while they are on waiting lists"

More than 5% of GPs surveyed also said they knew of patients who had died as a result of being denied treatment on the NHS.

Among those doctors was Sidcup GP Dr Richard Money who reported the case of a 70-year-old man who was awaiting surgery while acting as the sole carer for his wife, who had developed Alzheimer's Disease.

Dr Money said the patient was referred for surgery in 1997. Despite the fact that he had a poor outlook without surgery, he was kept on the waiting list for more than six months.

Eventually, his condition deteriorated, and he died after about a year after the initial referral while he was still awaiting surgery.

Nearly half - 45% - of GPs who responded to the survey said they were aware of patients whose treatment had been delayed on grounds of cost.

Ministers have repeatedly argued that rationing is not necessary in the NHS.

But doctors claim that, with finite resources, rationing is inevitable.

The British Medical Association wants the government to accept responsibility for rationing decisions and to consult the public over which treatments should be restricted on the NHS.

GPs fear the blame

GPs are concerned that they will be blamed by the public when treatments are denied, particularly from next April when they will be in charge of primary care groups, set up to decide how NHS money should be spent locally.

Dr Hamish Meldrum: "we need a public debate"

BMA GP negotiator Dr Hamish Meldrum said: "We have to make choices and set priorities, but that is increasingly having to be done in a uncoordinated way.

"People have been mucking around trying to avoid the word 'rationing' - what we would like is a whole public debate."

Three-quarters of GP respondents feared rationing would increase complaints against them, and nearly 80% thought it would cause friction in the doctor-patient relationship.

The survey also confirmed that there is real fear among GPs about the effect primary care groups will have on their public image.

Eighty-two per cent said they thought GPs would be held more personally accountable for rationing decisions.

GP fundholders are more likely to consider the cost of treatment when making the decision to refer or treat individual patients and are more likely to refuse treatment for cost reasons.

Thirty-nine per cent of GP fundholders admitted to refusing treatment for resource reasons, compared to just 30% of GPs overall.

North-south divide

The survey also revealed a stark north-south divide in healthcare, with southern patients the poor relation to those in the north.

Higher percentages of GPs in London (61%), the South-West/Wales (48%) and the South-East (47%) reported rationing or withdrawal of services in their areas than in the Midlands/East Anglia (45%), the North (41%) and Northern Ireland/Scotland (28%).

GPs in the South-east reported the highest knowledge of patients suffering harm as a result of treatment being delayed or refused and are also under the greatest pressure to reduce costs by not prescribing certain drugs.

According to the survey, family doctors are far more likely to be aware of services being rationed or withdrawn than their colleagues in the hospital sector.

Eighty-two per cent of GPs reported knowledge of rationing compared to 57% of consultants and 42% of doctors in the training grades.