Fife patients are being refused treatment by NHS Tayside, it has been claimed.
Campaigners say they have been told by senior staff that patients referred to the neighbouring health authority are routinely being turned away.
People in North East Fife have had the option of being treated by NHS Tayside for many years.
However, Liberal Democrat councillor Tim Brett said the arrangement appeared to be breaking down.
“It has been made clear to me that NHS Tayside are refusing referrals from NHS Fife and most concerning is that this is happening more often,” he said.
“The matter has been raised with me by senior staff at NHS Fife as well as GPs and patients.
“We are supposed to have a national health service and in particular, neighbouring health boards should be working closely together to benefit patients.”
North East Fife MSP Willie Rennie said locals had raised the issue with regards to the proposed closure of the GP out-of-hours service in St Andrews.
“I am very worried to learn that NHS Fife doctors are now telling us that referrals are being repeatedly refused by NHS Tayside and the problem is increasing,” he said.
“We need to know more about what is going wrong, so patients can get the care they need in a timely manner.”
A spokeswoman for NHS Tayside said there had been no change in its response to clinical referrals and no change to its acceptance of appropriate referrals from Fife.
She said Tayside and Fife out-of-hours services had a long standing agreement which means patients from Tayport, Newport and Newburgh can be seen in Dundee or Perth primary care emergency centres.
Since last April the out-of-hours service in Tayside has agreed to temporarily extend thi arrangement to Cupar, Leuchars and St Andrews overnight.
“In common with other unscheduled care services, out-of-hours can sometimes experience periods of high demand,” she said.
“However, all patients referred to the service as part of the agreement with Fife Health and Social Care Partnership have been seen by the out-of-hours service within clinically appropriate timescales.
“Each patient is triaged by NHS 24 before being referred to the service.”
NHS Fife medical director Dr Frances Elliot said: “NHS Fife works closely with our colleagues in Tayside to provide the best possible care for patients in the most appropriate location.
“In the small number of highly specialist cases where challenges do occur NHS Fife has strong working relationships with neighbouring health boards to ensure that patients gain access to care that they require.”