A health authority will deny operations to the obese and smokers for six months amid warnings from senior surgeons that the cost-cutting move is wrong.
NHS Harrogate and Rural District Clinical Commissioning Group (CCG) says smokers and patients with a BMI of 30 and over will be offered a referral to either a weight management programme or stop smoking service for a six-month period of health optimisation before being considered for an operation, as part of an £8.4 million savings plan.
In September, NHS England intervened to stop neighbouring NHS Vale of York CCG from imposing a similar policy after the Royal College of Surgeons raised concerns that proposals went against clinical guidance and made smokers and overweight patients soft targets for financial savings.
St Helens CCG was also recently forced to abandon plans to save money by stopping all non-urgent referrals for four months.
Commenting on NHS Harrogate and Rural District CCG's plans, Ian Eardley, vice president of the Royal College of Surgeons, said: "The policies for smokers and overweight patients that Harrogate and Rural District CCG intend to impose ignore the public outcry that surrounded similar plans announced by neighbouring Vale of York CCG in September.
"They fly in the face of the intervention made by NHS England to prevent those plans from going ahead.
"The Royal College of Surgeons is very supportive of encouraging patients to join programmes that help them lose weight or stop smoking before surgery.
"However making it a condition of receiving that surgery, no matter how sick they are or how much pain they are in, is wrong. NHS England has already said that denying operations to a particular group - such as smokers - is 'inconsistent' with the NHS constitution.
"NHS trusts and CCGs are desperately looking for ways to save money in very challenging times but singling out groups of patients is not the way to do it. We hope NHS England will now step in to prevent Harrogate and any other CGGs from targeting patients in this way."
The CCG's chief officer Amanda Bloor said: "The CCG has undertaken a thorough review of all the services it commissions based on clinical evidence to support the decision making process and I feel the measures we are taking encourage patients to take a greater responsibility for their lifestyle choices.
"It is vital that patients are given the skills and knowledge to take accountability for their own wellbeing to ensure we all lead healthier lifestyles.
"The CCG are not saying patients can't have the surgery. By introducing a six-month health optimisation period, we are encouraging and supporting patients to undertake a lifestyle change which will provide them with the best possible clinical outcome.
"The NHS spends around £9bn a year on patient care for those living with diabetes and with spending on obesity related ill-health and smoking related illness increasing year on year, these measures will help protect the future finances of the CCG and the wider local health economy."
The BMI and smoking policy will not apply to certain groups such as patients undergoing surgery for cancer, children and frail elderly people.