Doctors' leaders have thrown their weight behind the idea of 'super hospitals' serving half a million people each, claiming that local hospitals do not have the technology to save patients' lives.
They argued that politicians had to accept that many hospitals might have to lose their accident and emergency departments, and that acute medical and surgical services should be concentrated at fewer, larger centres.
In a joint report, the British Medical Association and the royal colleges of surgeons and physicians warn that going through a door marked 'casualty' is no guarantee that patients will receive a quality service.
Royal College of Surgeons president Sir Rodney Sweetnam said a lack of resources meant it was not possible to realise health secretary Frank Dobson's vision of patients getting the best treatment at their local hospitals.
He admitted doctors had failed to communicate the message that 'quality must take priority over access and convenience'.
'Patients have to realise that, just because they are in a hospital building which has A&E on the door, that does not mean they were going to get quality care.
'If a department does not have facilities and care is sub-standard, it should close.'
In a message to politicians, Charles Collins, who chaired the working party which produced the report, added: 'Either they want us to provide compromised care or quality care.'
The report says a hospital should serve 450,000-500,000 people if it is to provide the full range of acute medical and surgical care. There should be no single-handed consultants in any major sub-specialty, it says.
Shadow health secretary Ann Widdecombe urged ministers not to 'rush' into accepting the proposals: 'Patients confronted with a round trip of 100 miles or more to hospital would certainly not welcome these plans.'
Provision of Acute General Hospital Services. From Royal College of Surgeons, 0171-405 3474. pounds 10.