By Nick Triggle BBC News health reporter

Ambulances would be reserved for life-threatening cases

Demand on A&E departments has rocketed since GPs stopped routinely providing out-of-hours cover last year.

But cash and staff shortages have led some trusts to open minor injury units in smaller hospitals, sending serious cases to A&Es in larger hospitals.

Since June, three departments have been hit, but experts are predicting as many as another 30 may go in coming years.

Health bosses claim the changes have not affected patient care, but they have not happened without problems.

CHANGING FACE OF A&E Southmead Hospital, Bristol - A&E closed in June, becoming a minor injuries unit. Nearby departments told to take on extra patients Ormskirk Hospital, Lancashire - Department only treating children, and adults with minor problems. The unit had previously stopped doing night-time surgery Kent and Canterbury Hospital - Voted one of the best casualty departments in the country a few years ago, the unit was downgraded in January when it stopped taking trauma patients Princess Royal Hospital, West Sussex From June serious injuries no longer treated at the hospital A&E unit in a move which is expected to effect 3,000 patients a year Crawley Hospital, Sussex - The A&E unit closed in August 2004, within a month backlogs at the nearby East Surrey casualty department were being blamed on the change

Last year Crawley Hospital's A&E unit closed, leaving the nearby East Surrey department to take on the workload.

Within weeks, ambulance officials were reporting queues of up to two hours to get patients admitted.

There are about 200 accident and emergency departments in England run by 159 NHS trusts.

No central tally is kept of the number that have closed recently.

But Martin Shalley, president of the British Association for Emergency Medicine, believes health bosses up and down the country will follow the lead of the handful of trusts which have reorganised their A&E services.

"I think we will see a lot of activity. In some trusts there is more than one A&E department, so I think we will see many looking at whether this is necessary.

"Money is short, so trusts have to look at where savings could be made."

He believes that it would be realistic to have 170 A&E departments as some experts have predicted.

"NHS trusts are reconfiguring their services and in some cases it will be better for patients to have a fully staffed team at one site, we just have to make sure that they do not go too far."

Concern

But Simon Williams, director of policy at the Patients Association, said while in some areas it may make sense, the trend was still concerning.

He warned A&E had seen its workload increase since a new GP contract came into force last year allowing doctors to opt out of providing out-of-hours care.

Figures show that in the most recent 12 months there was a 10% rise in A&E admissions.

Mr Williams said: "If there are too many closures we could have a situation where there is no out-of-hours cover."

The Department of Health spokesman said A&E was a matter to be decided on a local level.

"Obviously there must be sufficient provision of services, but the government would not get involved in decisions about local services."