EMERGENCY casualties in Cheltenham will be sent to Gloucester at night instead, under controversial new plans for the county's hospitals.
It comes as the trust faces a shortage of doctors to cover the hours in the town's hospital.
It is part of a national crisis to recruit staff into emergency medicine. Under the plans, an estimated 16 patients will be transferred to Gloucestershire Royal Hospital for emergency care every night, rather than being seen in Cheltenham General Hospital.
Travel times from Tewkesbury and the north Cotswolds will increase for some patients collected by ambulance.
Other proposals would see paediatric day care move to Gloucester, but improvements would be made to Cheltenham's cardiac care.
Health chiefs insisted no jobs were at risk, but said the plans were part of an urgent move to improve patient safety. The changes will not save any money from existing running costs.
A&E consultant Dr Tom Llewellyn said the changes were the best way to use existing staff.
He added: "Clinicians have been discussing how best to overcome the challenges we face and how to make best use of the specialist staff and skills available.
"We believe this proposal will help us provide safe, timely services to the people of Gloucestershire, 24 hours a day, seven days a week."
Doctors will see still see patients at night in Cheltenham's A&E if they have been sent to the hospital by a GP.
But patients who have critical illnesses at night or are in need of emergency treatment will be taken direct to GRH.
John Oliver, from the South West Ambulance Service, said the changes would only increase travel times for a small percentage of 999 patients.
"Increased clinical skills within the ambulance service means around half the patients we attend do not need to go to A&E," he said.
"For many patients needing to go to hospital, A&E is not the best place to take them. Specialist locations are often further away than the nearest A&E."
It is hoped the changes will improve patient safety as there is less demand for emergency treatment at night and it is harder to get medical cover from doctors.
Medical director Dr Sean Elyan insisted Gloucestershire Hospitals NHS Foundation Trust remained committed to both hospitals. He said: "When people need specialist hospital services, we need to make sure they are organised in a way that will ensure quality of care, safety of patients and make best use of the resources and expertise available."
Dr Caroline Bennett from Cotswold Medical Practice, Bourton on the Water, said fresh challenges had forced the change. "No change is not an option and services need to adapt to overcome the current challenges," she said.
But Unison South West spokeswoman Tanya Palmer, was concerned over the impact on staff and patients in the north of the county.
"I would seriously question if this was financially motivated, despite what the trust says," she said.
"There are serious concerns about how increased journey times will effect people there who need emergency treatment."
MP Martin Horwood is also seeking more information.
"I want a concrete plan saying how we are going to stop services being chopped bit by bit," he said.
From August 2013, there is no guarantee the trust will have the numbers of doctors it currently has, so it needs to plan now to ensure patient safety.
Critically ill patients needing emergency treatment will be transferred from Cheltenham General to Gloucestershire Royal Hospital at night.
The Emergency Care Centre at CGH will be nurse-led under the proposals, with specially-trained staff capable of treating the majority of walk-in patients.
Doctors will continue to be on site at CGH to receive patients who had previously been reviewed by a GP.
Extra beds needed to cope with more emergency patients at GRH will be freed up by some specialist services transferring to Cheltenham.
â For example, the proposal will improve facilities in the county's cardiac intervention unit at CGH by providing more beds in the unit and reducing delays there, particularly for those needing complex procedures.
Patients with non-critical gastrointestinal and respiratory conditions will also go to Cheltenham.
An emergency bay will be provided at GRH for critical gastrointestinal conditions and some beds provided there for emergency respiratory conditions.
More beds will be freed up to cope with extra emergency demand and trauma cases at GRH.
Gastroenterology and liver patients will be treated in Cheltenham.
â The proposal is to concentrate the majority of beds for non-urgent gastroenterology inpatient care at CGH, while keeping a service for other patients in a single emergency bay at GRH.
The NHS in Gloucestershire will be holding a series of public drop-in events across the county during the 12-week engagement period.
Information is available online at www.nhsglos.nhs.uk.