The hospital is a specialist unit treating people from around the UK

Robert Jones and Agnes Hunt Orthopaedic Hospital (RJAH) in Shropshire says it has treated more of the county's patients than it has been paid for.

It warned last week that it may have to stop treating people from Powys.

Powys Local Health Board says it will pay for a set number of RJAH operations but some patients may go elsewhere.

In Gobowen, near Oswestry, the RJAH is only a few miles from Wales, and about 40% of its patients are from Powys and north Wales.

At the moment, there are an estimated 600 patients on waiting lists and a further 800 out-patients from Powys at RJAH.

Under new plans, Powys LHB will take control of the orthopaedic waiting list previously managed by the hospital and pay for a set number of operations.

It's deeply depressing that due to financial constraints some of these operations will be carried out elsewhere Glyn Davies AM

The LHB said patients could also be treated in Powys and at hospitals outside the county, but it said at this stage it could not reveal their locations.

The LHB added that it would write to the RJAH's 1,400 Powys patients to explain the situation.

Health watchdog Montgomeryshire Community Health Council, said it would be "concerned" if large numbers of patients were transferred to other hospitals.

Chief officer John Howard said community hospitals in Powys were not capable of orthopaedic surgery and doubted whether others elsewhere could cope with an influx of patients from Powys.

'Difference of opinion'

In a letter to GPs and other officials in the county, Andy Williams, chief executive of Powys LHB, said: "This agreement has been reached in view of difference of opinion between the two organisations regarding the prioritisation of patients and the funding required in order to ensure the achievement of Welsh access time standards."

Of the new agreement with RJAH, he said the LHB operated a similar system with Hereford Hospitals NHS Trust and "after some initial difficulties" the system now worked.

But he admitted that initially there could be "some confusion".

Conservative Mid and West Wales AM Glyn Davies said orthopaedic patients were facing a uncertain time.

"It's deeply depressing that due to financial constraints some of these operations will be carried out elsewhere, when historically people from Powys have been treated at RJAH," he said.