Smokers and overweight people due to get non-emergency surgery in north Essex will be forced to get help if they want their treatment to be paid for by the NHS.

The proposal from the North East Essex Clinical Commissioning Group (NEE CCG) is one of a number of steps it is considering introducing in a bid to make services more efficient.

Other measures include no longer providing IVF, vasectomies or female sterilisation to people other than those with complex health needs, and to stop prescribing gluten-free food to patients, except young people, pregnant or breastfeeding mums, as such products are now widely available.

Other commissioning groups elsewhere have already made decisions to stop similar services, but the NEE CCG has so far resisted such a move.

It has already made £35million in savings in the past four years, and must save a further £22m this year.

Dr Gary Sweeney, NEE CCG chairman, said: “We have done a lot of work adding savings, but we are at the stage where all the efficiencies have been done and we have to look at not buying some services.

“The dilemma we have is if it is not these ones it would have to be another list of services. Somewhere we have to make a difficult decision, hopefully we are doing it in a logical way.

“We have taken these decisions through the correct channels, with local doctors and nurses involved, not managers locked away somewhere.”

Under the proposals all patients being referred for non-urgent elective surgery who smoke will be referred to stop-smoking services, while overweight patients will be encouraged to lose weight before their operation.

However failure to attend such programmes “may have an impact on whether individuals could undergo their procedure”, the report says.

The existing IVF service would be decommissioned “as it does not provide sufficient benefit to the overall health economy”, though an exception would be made for people with exceptional circumstances, such as those undergoing cancer treatment.

The vasectomy and sterilisation service would also only continue for selected patients, as it is “a service with no or limited clinical value – rather it is considered as one of many forms of contraception”.

Some decisions are fairly certain, but more controversial ones will undergo some limited further consultation – though Dr Sweeney has warned time is running out for extended “navel gazing”.

Dr Tom Nutt, chief executive of Healthwatch Essex, said: “In difficult financial times we understand services need to be streamlined and sometimes cut, but we hope NEE CCG have talked to patients about how the change will affect them.

“Patient experience should be at the heart of their considerations.”

The CCG has said it will consider re-implementing some or all of the services should its financial situation improve.

The board meets on Tuesday May 26 from 2.30pm at the Colchester Primary Care Centre, in Turner Road to discuss the plans. The meeting is open to the public.