By Thomas Moore, Health and Science Correspondent
Specialist emergency care could be concentrated in regional hospitals under radical plans for a two-tier A&E service.
NHS England is considering the new-look service as part of a major shake-up of emergency care.
It says other A&E units would not be run down and would still have the staff and resources to treat seriously ill patients.
But according to Professor Sir Bruce Keogh, NHS England's Medical Director, critical patients with complex life-threatening problems need expert care - even if it means travelling further in an ambulance.
"We have demonstrated the benefits of transferring patients far outweigh any differences in travel time," he said.
"For example, stroke care in London, where the number of services has been reduced from 32 to eight, has resulted in a significant increase in survival and a return to independent living."
Some A&E departments could end up dealing with less serious injuries A panel of doctors has drawn up the plans for NHS England in an effort to stem the rise in demand for emergency care. The number of hospitals breaching treatment time targets has trebled in the last year.
The plans would mean many more patients being treated in the community.
:: Patients with minor problems would be given more support to look after themselves.
:: There would be an enhanced 111 phone service, with patients speaking directly to doctors and nurses.
:: And there would also be seven-day appointments with GPs.
Dr Clare Gerada, head of the Royal College of General Practitioners, cautiously welcomed the plans.
"Of course it's important that patients get the same quality of service on a Sunday afternoon as a Tuesday morning," she said.
"But it's equally important that in the quest for seven-day working we don't remove resources from where they are best used, which is in general practice, and when patients see us most, which is in the working day."
The plans also suggest specially trained paramedics could treat many 999 patients at home rather than simply transporting them to hospital.
The South East Coast Ambulance Service already has some 'paramedic practitioners', who keep 30,000 patients a year out of A&E.
Sky News spoke to 92-year old Gwendolyn Kimpton, who had a badly infected wound dressed by one of the paramedics. She said she was relieved not to be going to hospital.
"I would have been a bit frightened, I must admit," she said.
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