In its revised NHS Efficiency and Productivity Framework the Scottish government sets out how it expects NHS boards to achieve a 3 per cent efficiency saving this year.

It is vital that primary care teams have access to data to identify 'unwarranted variation' in referrals, the Scottish government said. 'This could reduce the demand placed on acute services and avoid unnecessary hospital visits,' it added.

The Scottish government also said shifting the balance of care from acute to primary care locations is 'critical' to allow the health service to reduce costs.

'In addition, shifting the balance of care, allowing greater self-management especially for chronic diseases will not only provide greater control to individuals of their own disease but will allow resources to be utilised for those most in need,' the framework says.

Work is also underway on the package of enhanced services for Scotland in 2011/12, it says.

This will focus on reducing costs and improving quality in prescribing, inappropriate variation and preventing avoidable emergency admissions.

Scottish health secretary Nicola Sturgeon said the tougher efficiency targets for NHS boards are 'absolutely right' in the current financial climate.

'We should be constantly looking at service improvement with the priorities being on safety and quality,' she said.

Dr Dean Marshall, chairman of GPC Scotland, said: 'While we recognise there is intense pressure to make savings, we would urge NHS managers to work with us to plan to make the savings needed to ensure that patient care is not the first casualty of spending cuts.'