There are just two years left to save a universally free NHS, doctors' leaders are warning.
Patients can expect to see beds closed, services reorganised and hospitals shut as reforms begin to bite and managers try to do more for less, they said.
A process of "creative destruction" was just beginning in the NHS, health policy experts warned doctors at a British Medical Association conference.
And this would intensify as high levels of investment tailed off in 2008.
Chairman of the BMA James Johnson said it was particularly controversial time, with record deficits and a raft of reforms after significant extra investment.
'Creative destruction'
"After five years of 7% growth per annum the NHS is in a bit of a mess.
"We only have another two years left and after that we will go back to growth levels of 2-3%."
If the NHS could not provide a better service with 7% growth rates, he said, how could it expect to do it lower rates of investment.
"What we believe in most of all is an NHS free at the point of use. If we want that to continue we have probably got two years to get that right," Mr Johnson said.
At a conference looking at whether government reform programmes currently being pushed through made sense, health experts warned that huge unavoidable changes were ahead in the NHS.
Chris Ham, professor of health policy at Birmingham University, told doctors extra investment had led to big improvements in care from the patient point of view.
But he added: "The NHS hasn't improved sufficiently to persuade the public it can survive as a universal, free at the point of use system."
Politicians were on a "journey of creative destruction" in a bid to obtain more value for money, he added.
He said there was an element of deliberately taking risks and "destroying the old ossified features of health care".
A new NHS would be created out of the "shell of the old NHS that has been left behind", he added.
Reforms like allowing independent sector treatment centres take on non-urgent operations and increasing the amount of health care provided by the private sector was leading to "surplus capacity" and more beds than were needed.
This would mean hospitals either competing aggressively to fill their beds or take a decision to close them and cut costs, he said.
'Mergers and acquisitions'
As the reform process continued, there would be "mergers and acquisitions" with one hospital taking over another as health care providers sought to protect their position.
But he said there would come a point where politicians found it difficult to live with the consequences of the reform process they had begun.
Dr Hamish Meldrum, chairman of BMA's GPs' committee, said: "There are areas now in London for example where there seems to be an over-capacity.
"If that was industry or a supermarket and you had overcapacity it would be closed, but closing a hospital is a political minefield."
He also warned that hospital work could not be taken over by community providers unless there was the capacity in the community.
Former Downing Street policy adviser Simon Stevens, an architect of many of the government's reforms, said that just to do the same without making any improvements in productivity ate up 4% of GDP a year.
But every 1% of growth in the NHS productivity freed up £1bn in health spending.
He said reforms like payments by results, whereby hospitals are paid per patient treated rather than in lump sums based on past activity, were being introduced to give trusts an incentive to do better.
Government optimism
A spokesperson for the Department of Health said: "We don't agree with this doom-laden and pessimistic prediction.
"The NHS has just had one of its best years ever, tackling waiting times and improving the quality of services across the board.
"Reforms like offering patients a greater degree of choice are the solution, not the problem, and are key to the NHS's future success.
"The changes will improve the way the NHS works and ensure every penny of extra NHS investment is spent wisely."
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