Strategic health authorities and primary care trusts should not be left to redesign emergency services locally without national planning, Royal College of Surgeons president Bernard Ribeiro has warned.
Mr Ribeiro said decisions about the shape of emergency services should not be left to trusts and PCTs whose top priority is to balance the books.
'There needs to be a global view on this, it can't be done by SHAs or PCTs alone,' he said.
Mr Ribeiro is calling on the government to draw up a national plan for emergency services which he says should consist of a network of hospitals providing three levels of care. The top tier would have all major surgical specialties, 24-hour resuscitation and back-up and a helicopter trauma service.
The second tier would provide a 24-hour service but not all major surgical specialties. The third would serve fewer than 200,000 people in a remote area and be able to treat and transfer patients to other hospitals.
'We are not talking about closure of emergency services; we are talking about redefining how those services are used.'