The NHS deficit topped �500m last year

In his first interview last week, NHS boss David Nicholson said emergency services may be centralised in super hospitals under plans being drawn up.

Both the British Medical Association and Royal College of Physicians said changes were needed.

But BMA chairman James Johnson added they could lead to the small hospitals left behind being "whittled away".

Mr Nicholson, who took up the health service reins at the beginning of September, said "tough decisions" needed to be taken.

To suggest that this is all part of some rational planning process is nonsense Geoff Martin, of Health Emergency

He said the changes could affect every region, and may lead to emergency, maternity and paediatric care being centralised in fewer hospitals.

He said the moves were needed to balance the books, but added it was also about improving services by providing the best care in fewer centres, although he acknowledged this would mean patients travelling further for treatment.

But Mr Johnson said: "Many people including doctors and nurses are fearful if you take A&E away from hospitals other services will be whittled away and eventually closed.

"Small hospitals must remain and have a range of services such as minor injury units, GP walk-in centres, planned surgery and intermediate care beds."

Inevitable

But he said centralising care was a way of providing better services as large centres were needed to keep pace with technological advances.

"All this makes change inevitable. There is no point burying our heads in the sand."

Ian Gilmore, president of the Royal College of Physicians, agreed care must be taken to ensure services left behind met patient needed.

But he added: "Leaving aside financial cutbacks, the pressure on medical staff due to reducing junior doctors' hours to comply with the European Working Time Directive has made it increasingly difficult to maintain full emergency services running 24 hours a day in many hospitals."

However, campaigners maintained the hospital reconfigurations, some of which have already started, were being driven by cost.

Geoff Martin, of the Health Emergency campaign group, said: "To suggest that this is all part of some rational planning process is nonsense.

"What we are looking at is a cash-driven avalanche of panic cuts and closures which will have deadly impact on patient care."

A Department of Health spokeswoman said while the NHS was changing it did not mean "wholesale closures of district general hospitals".

And she added: "Reconfigurations are locally-led solutions to address local issues and we would stress that any decision on significant changes to services will only be made after full public consultation with local people."