Controversial plans for the future of the NHS risk being used as a cover for the £22 billion worth of cuts required to balance spending, the British Medical Association (BMA) has warned.
The union's head, Dr Mark Porter, said there is a danger the plans are being "used as a cover for delivering cuts, starving services of resource and patients of vital care".
Health managers in 44 areas of England have been ordered to draw up sustainability and transformation plans (STPs), setting out how they will reduce costs, change services and improve care in the wake of a record £2.45 billion deficit for the last financial year.
The STPs, some of which have been published or leaked, could see some hospitals, A&E units or maternity units close, and other services merged.
The proposal for Cheshire and Mersey includes the downgrade of at least one A&E department, while in north-west London, there are plans to reduce the number of sites offering a full range of services. Birmingham and Solihull's STP proposes a single "lead provider" for maternity care.
The BMA said the cuts would need to be achieved by 2020/21 to achieve financial balance.
- Dr Mark Porter spoke to ITV's Good Morning Britain:
The BMA's analysis is based on savings figures found in documents from 42 of the 44 areas.
An accompanying BMA survey of 310 doctors in England found that 64% had not been consulted on STPs. A third said they had never heard of STPs, while a fifth did not support their introduction.
Earlier in November, analysis by the King's Fund think tank said the plans had been kept secret from the public and barely involved frontline staff or patients.
The Kings Fund added NHS England had told local health leaders not to reveal the plans until they were finalised and had been approved by their own officials.
The national body even told local managers to refuse applications from the media or the public wanting to see the proposals under the Freedom of Information Act.
NHS England and some health experts argue that STPs will improve patient care and are necessary to fulfil Health Secretary Jeremy Hunt's plan for full seven-day services.
But campaigners say they are just a way of cutting services.
Dr Porter, chairman of the BMA's council, said: "STPs have the potential to generate more collaboration and the longer-term planning of services based on local need. But it is crucial that any plans about the future of the NHS must be drawn up in an open and transparent way, and have the support and involvement of clinicians, patients and the public from the outset."
Shadow health secretary Jonathan Ashworth said: "These warnings that the proposed changes to local services in STPs are overwhelmingly driven by cuts - £22 billion of them - will set alarm bells ringing and rightly so.
"It's amazing that the Government can claim that these plans are clinically driven when two thirds of doctors say they haven't even been consulted.
"What's been revealed so far are drastic proposals to cut beds and services. It's simply not acceptable for these decisions to made behind closed doors."
NHS medical director Professor Sir Bruce Keogh said the NHS is "constantly adapting to improve services for patients", adding: "By continuing to adapt to a changing world, the NHS will be able to secure a better service for future generations."