Hospitals and A&E departments could be closed as part of plans to try and plug the gaping gap in NHS finances.
A set of new draft sustainability and transformation plans (STPs), which suggest ways for the health service to become more efficient, have been seen by the BBC.
The plans are said to suggest cutting beds and closing A&E departments in some areas.
Earlier this year health leaders around the country were tasked with planning how they will deliver a “sustainable and transformed” health service which will improve quality of care and NHS finances.
The draft STPS were uncovered by the campaign group 38 Degrees, which said 44 plans are being drawn up for each area of England.
Director Laura Townshend said the proposals to close some services show the NHS is “dangerously under-funded”.
The plans are due to be signed off in October, she said, and there hadn’t been transparency over what they involved.
She said: “These proposed cuts aren’t the fault of local NHS leaders. The health service is struggling to cope with growing black holes in NHS funding. These new revelations will be a test of Theresa May’s commitment to a fully-funded National Health Service.
“The NHS belongs to all of us - so local people should get a say in any changes to their local services.”
One of the STPs is reported to include a plan to close the A&E at the Midland Metropolitan Hospital.
The STP also suggests merging two of the area’s three district general hospitals and closing one site.
Another plan, for Leicester, Leicestershire and Rutland, proposes reducing the number hospitals in the area from three to two.
The Guardian reports that the plan for north-west London outlines a way to reduce the number of face-to-face meetings between doctors and patients by using “virtual consultations”.
Chris Hopson, chief executive of NHS Providers, which represents frontline NHS leaders, called on Health Secretary Jeremy Hunt and NHS England boss Simon Stevens to admit that there is a disparity between what the NHS is being asked to achieve and the money that is available to do it.
He warned there could be a “glut” of hopsital services being shut down because there were too few senior consultant staff.
“As we go round and talk to those smaller district general hospitals (DGH) that are running marginal rotas in lots of ‘ologies’ - rheumatology, dermatology etc - we are increasingly finding that people cannot find the senior consultant staff in order to keep those rotas up and running,” he said.
“Our members tell us that they are struggling to keep services open because of workforce shortages and they therefore face really difficult decisions about; do you close down something either permanently or temporarily because you cannot staff it safely?”
He added: “NHS Improvement, when asking our guys to improve their financial position, one of the places they have been asked to look at is ‘please identify your marginal acute services where you are trying to prop up what is really an unsustainable rota’.
“So we would expect to see a bit of a glut of those kinds of decisions going forward because our guys have been specifically asked to identify them.
A NHS England spokesman told the BBC: “It is hardly a secret that the NHS is looking to make major efficiencies and the best way of doing so is for local doctors, hospitals and councils to work together to decide the way forward in consultation with local communities.
“Proposals are at a draft stage but we expect all local leaders to be talking to the public and stakeholders regularly - it is vital that people are able to shape the future of their local services.
“No changes to the services people currently receive will be made without local engagement and, where required, consultation.”
A Department of Health spokesman said: “We have given the NHS the money it has asked for in its own plan for the future - an extra £10bn per year by 2020, including almost £4bn extra this year, and we’re helping hospitals by clamping down on expensive agency staff and identifying inefficiencies.
“We expect the NHS to focus on balancing the books whilst continuing to provide high-quality care for patients.”
The comments come as a new NHS Providers’ survey of 84 NHS Trust and Foundation Trust finance directors found that while many were optimistic about the first three months of the financial year, 38% say they are not confident they will meet financial targets set by regulators this year.
Commenting on the NHS Providers’ survey, shadow health secretary Diane Abbott said: “This is an indictment of Tory underfunding and mismanagement, with four out of 10 NHS Trust finance directors saying their current performance and financial position are unsustainable.
“The Government should properly fund the NHS and address the real waste of PFI, a ballooning agency staffing bill and overcharging by Big Pharma.”
Mr Hopson’s warning came as figures showed the size of the deficit for NHS trusts in England had halved over the course of a year, with more trusts meeting their financial targets.
With the total deficit falling to £461 million for April to June, down from £930 million in the same period last year, health experts are nevertheless warning it would be a “mistake” to think financial pressures have eased.
The NHS Improvement report also highlighted a reduction in the number of trusts reporting a year-to-date deficit, with a decline from 190 to 153 - a drop of almost a fifth (19%). But a majority of the 238 trusts in England are still running a deficit.