Some patients in need of hospital treatment aren't even making it to the waitlist.  

A letter obtained by RNZ reveals some referrals from an orthopaedic clinic are being knocked back. 

It says it lacks the resources to see all patients within the Ministry of Health waiting time targets. 

Royal College of GPs Medical Director Dr Luke Bradford told Ryan Bridge the acceptance level fluctuates normally, but the threshold rises as more pressure's applied to the health system.  

He says the health targets have people being seen within four months and being operated on quickly, and one way to manage that is by not taking patients onto lists in the first place. 

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