Doctors in the West have warned that they will be facing a £60 million a year financial black hole within seven years unless they get more money or the way the NHS works can change.
GPs in Wiltshire, who took over the running of the NHS in the county officially a year ago, are so worried about the shortfall that they are touring the county to take their ideas about how they see things needing to change between now and 2021.
The Clinical Commissioning Group is a collective of all Wiltshire's doctors, and run doctors' surgeries, minor injury units and community services, but they face huge pressures both in terms of financially and with a shortage of doctors.
The CCG chair, Dr Stephen Rowlands, said: "If we carry on doing what we're doing and have no increase in budget, we will be £60 million overspent by 2021."
The doctors said they believed one way to save would be for patients to use acute hospitals less – the CCG pays those larger hospitals each time – and for care to be based more locally.
Another way would be for a shift in the culture where families have to take responsibility for their own health.
"I'm not saying we're going to ration healthcare but it has to be used appropriately," he added.
But the shortage of doctors would be another factor: a recent survey in the Wessex GP committee area – which covers Wiltshire and Dorset – found that 430 GPs were nearing retirement, but only 300 were being trained.
Earlier this month, the Wessex group of doctors discussed the idea of charging patients to visit their GPs.