Community health councils 'lack a clear focus for their activities' and stretch resources 'unproductively', according to a Welsh Office document setting out stark options for change.
Involving the Public says 'confusion about their role' means CHCs are 'poorly equipped' to make 'value-adding' contributions to strategic debates and balance local lobbying roles 'with the wider development of services'.
'Moreover, they have remained relatively unchanged while the NHS generally has undergone significant change and development since they were established,' it says.
The consultation paper suggests CHCs should refocus their activity on trusts or health authorities.
With a trust focus, CHCs would help to develop services 'within trusts in their area', support individual patients and advise on local user involvement.
With a HA focus they would provide an 'expert source of advice' on public opinion, represent local people at 'strategic levels' and support the NHS complaints procedure 'rather than individuals'.
HSJ understands that drafts of the paper contained just the 'HA focus' option. The final document, issued last week, says trust-based representatives would take up 'support and advice to individual patients'.
It also suggests CHCs could be reorganised into 'one per HA'. Wales has 22 CHCs currently and five HAs.
Sue Wilshere, chief officer of the Association of Welsh Community Health Councils, said: 'I think it would be difficult to argue with the idea that CHCs have tried to do too much over the years with limited resources.'
She 'suspected' the 'HA focus' would appeal to many Welsh CHCs, but added: 'That does raise questions about how CHCs would maintain their local links.'
Involving the Public has a wider focus and outlines ways for the health service to establish 'genuine' partnerships with the public and users.
It says trusts should consider appointing patients' representatives as board members, and HAs could use 'modified citizens' juries' when drawing up health improvement programmes.
Launching the document, Welsh health minister Jon Owen Jones said: 'Effective patient and public partnership is crucial to the NHS of the future.'
Involving the Public. Welsh Office, Cathays Park, Cardiff, CF1 3NQ. Responses by 20 November.