Epsom and St Helier University Hospitals trust is considering splitting into two new organisations.
The trust, which had a£7.26m, deficit in 2006-07 and an£827,000 surplus in 2007-08, may also transfer some services to another acute trust, primary care trust or independent provider.
The trust falls across a strategic health authority boundary, with St Helier Hospital in London and Epsom General Hospital in Surrey, which is covered by NHS South East Coast. Chief executive Samantha Jones said that the trust needed to keep "services local, but within finite resources".
The trust and Sutton and Merton primary care trust also published proposals to spend£215m improving St Helier Hospital and developing four health centres. Epsom General Hospital is not mentioned in the plans because, the trust says, Surrey PCT will review acute care in the county separately.
A project board is being established for the structural review, chaired by NHS London and with representatives from Epsom and St Helier, Sutton and Merton and Surrey PCTs, NHS London and NHS South East Coast. It is expected to report in spring next year.
NHS London chief executive Ruth Carnall said the review would offer "certainty to the local community and staff."