NHS North West London A&E units downgraded
Accident and Emergency (A&E) units at four London hospitals are to be downgraded.
The move affects Charing Cross, Central Middlesex, Hammersmith and Ealing hospitals.
More serious emergencies will instead be referred to A&Es at Hillingdon, Northwick Park, West Middlesex, Chelsea and Westminster or St Mary's hospitals.
The decision was confirmed at a joint committee of Primary Care Trusts in Westminster.
NHS North West London said the changes would save money and improve care.
It said the move would address the increase in non-acute cases arriving at A&Es, an ageing population with long-term conditions and the drop in the quality of care received in hospitals at night and at weekends.
But campaigner Anne Drinkell, a former nurse, said she thought the proposals were budget-driven not not clinically-driven.
Andy Slaughter, Labour MP for Hammersmith, said the decision left a "second-class health service for millions of Londoners" and that the A&Es left would be "over-crowded and over-run".
Julian Bell, leader of Labour-run Ealing Council said: "We are going to fight this decision all the way."
He said statutory powers would be used to refer the decision to the secretary of state for health.
"We will also keep our options open with a judicial review," he added.
Those hospitals losing their A&E units will become 24-hour GP-led "urgent care" centres.
They will still offer outpatient and diagnostic services such as physiotherapy and X-rays, but they would not be able to treat life-threatening conditions such as strokes, internal bleeding and heart attacks.
These cases would be referred to the remaining five major acute hospitals with 24-hour A&Es and urgent care centres.
Dr Mark Spencer, medical director of North West London NHS, said: "What we are recommending across north-west London is that we develop five bigger, better hospitals than we have at the moment.
"We can have consistently large teams of consultants making sure people get the very best care and in return for that we need to make some of our hospitals smaller designed around the services they need for their local community."