Patients should pay for minor cosmetic surgery, they suggest, and neurosurgical instruments could be sterilised then reused

The NHS should charge patients for minor cosmetic operations such as removing warts and other skin growths in a bid to help it meet its required £20bn savings target, doctors will urge tomorrow.

The suggestion is one of dozens by senior doctors to save money while still giving patients the same standards of care. They are contained in a report by the NHS Confederation, which represents most hospitals and other NHS services in England.

"If the NHS was clearer about what it does and does not treat, it could take a different approach to these procedures by, instead of banning them, telling patients that they can pay to have them done," the report says.

It cites skin tags, benign growths that are sometimes associated with obesity, and harmless warts that are usually found in those over 40, as examples.

The report distils the views of leading doctors, representing organisations such as the British Medical Association and Academy of Medical Royal Colleges, who were asked to suggest ways the NHS could find the £20bn of savings which chief executive David Nicholson has told it to make by 2014-15.

The other measures which seven groups of specialists doctors cite in the report, Clinical Responses to the Downturn, include:

• Scrapping rules brought in after the CJD scare that force neurosurgeons to throw away surgical instruments after just one use.

• Greatly reducing the "grossly overused" practice of patients undergoing an MRI scan. As many as 80% of such scans may be clinically unnecessary, it says.

• GPs referring fewer patients unnecessarily to see a hospital specialist.

• Treating everyone with a broken hip, knee or limb within 48 hours, to minimise their stay in hospital.

"Suggestions like these, from some of the most respected clinicians in their field, simply have to be taken seriously," said Hugo Mascie-Taylor, the NHS Confederation's clinical director.

"There are huge challenges facing the health service, but what is heartening about this report is that there are ways both to save money and improve the care we provide to people." However, the report also notes that "numerous initiatives are under way to try to identify where money can be saved, yet feedback we received suggested that very few of them were engaging doctors in any meaningful way".

The report comes as the health secretary, Andrew Lansley, prepares to spell out tomorrow whether or not he will slow the breakneck pace of reform which he has outlined for the NHS in England, which some senior doctors have warned will entail the breakup of the service and potential privatisation. "We believe in the NHS and are committed to delivering continuous improvements in services. Every penny saved from efficiency savings will be reinvested back into patient care. That includes a 45% cut to bureaucracy," said Lansley. "It is far more effective if health professionals are engaged in this. I welcome the important work they are doing to meet efficiency savings whilst ensuring high quality patient care".