Belfast's Royal becomes 'main hub' for emergencies
Belfast City Hospital's Accident and Emergency Unit will close at 08:00 GMT on 1 November.
According to management, the move is temporary and unavoidable due to the shortage of senior medical staff.
People who arrive at the department and who are considered to be non-emergency cases will be redirected two mile across the city to the Royal Victoria Hospital instead.
Emergency cases will be sent by ambulance.
The change to the Belfast Health Trust service will see the Royal Victoria Hospital's A&E department becoming the main hub of emergency care in Belfast.
People will be seen by a triage nurse and either treated at the Royal site or sent to the City or the Mater Hospitals, depending on their condition. They could also be advised to attend the GPs' out-of-hours service.
Extra emergency nurse practitioners who can treat and discharge patients will be available to try and reduce waiting times.
The co-director of acute services at the trust, Bernie Owens, is leading the team involved in implementing the changes.
"The Belfast Trust will be operating a single emergency service across the three acute sites. So when a patient turns up at the Royal Victoria, Belfast City or Mater Hospitals, they can expect to be admitted to any of three acute sites," she said.
Mrs Owens said patients who are admitted by their GP will go directly to the Belfast City Hospital, by-passing anyone else waiting to be seen.
Management admit they would have preferred more time to prepare for the change, but maintain that keeping the service the same as it was, was unsafe for patients.
The trust's medical director, Tony Stevens said the move was clinically, as opposed to financially, motivated.
"This is about treating patients in a safe environment. There will be problems along the way. We expect that. We are doing our best to prepare for every eventuality. "
While health unions accept there are not enough senior doctors to work the rota, they believe management are seizing the opportunity as an excuse to permanently shut the department.
A trade union representative from Belfast City Hospital told the BBC that closing the south Belfast department could have disastrous consequences.
Tommy Steenson said that while he sympathized with management over the length of time they had to prepare, the plan had not been properly thought through.
"Can you imagine the fights that will break out in the Royal at the weekend when crowds from both sides of the divide are sitting in the waiting room - it could be a disaster," he said.
The three-mile radius which separates Belfast's three A&E's, has long been a bone of contention among the public, politicians and doctors. While health unions argue all three are required, senior health officials maintain the move will create a more efficient health service.
Pressed about the likelihood of the City department opening again, Mr Stevens insisted the move was temporary.
"We are still actively looking for senior doctors but as this has not produced any results in the past 12 months, it is looking unlikely that we will do so now. Whether or not the department remains closed will depend on the outcome of the public consultation, but the final decision rests with the minister."
The RVH anticipates that it will have to deal with an extra 30,000 patients a year. To cater for the extra footfall, there will be a new nine-bed short stay unit. In addition, there will be an acute medical admissions unit that operates 24/7 for patients who need a longer stay.
The changes come as new figures reveal that the Belfast Trust is already struggling to cope. Latest waiting times published by the Department of Health reveal that 95 people waited in the unit longer than the 12-hour target last month.
Nurses who worked on the City's emergency site were offered the chance to state their preference - whether to work at either the Royal or the Mater hospitals. A majority of the 76-staff have moved. A small number of administration staff remains.
Meanwhile, building contractors at the Ulster Hospital in Dundonald, are working around the clock to ensure that new wards will be available for the extra patients they inherit as a result of the Belfast closure.
The director of hospital services at the South Eastern Trust, Seamus McGoran, warned that November would be difficult for both patients and staff.
"November will be a challenging month as not all of the additional capacity will be in place from 1 November," he said.
Despite already having the busiest A&E in the Belfast area with 75,000 patients a year, Ulster Hospital officials expect to see an extra 10,000 patients a year.
That will mean an additional 2,000 admissions. Waiting times at the Ulster Hospital also reveal staff are under pressure, 617 people had to wait more than 12 hours between July and September.
A number of measures are being put in place to cope with increased numbers.
There will be more staff in the Ulster's A&E, but elective surgery at the hospital will be restricted for four weeks.
Other measures include opening two wards and offering more day procedures where patients are not admitted to hospital.
While senior management at the South Eastern Trust remained upbeat about the changes, when asked by the BBC if they were optimistic plans would run smoothly, Mr McGoran admitted that they were "heading into the unknown".
"With winter coming and the flu season with it, we are heading into the unknown. Let's say we are praying for no disasters."
With just five days to go, workmen are trying to complete the two extra wards, while staff are also installing medical equipment. It is hoped that one ward will be opened by the first weekend in November, while the second will be completed by December.
"The staff have been fantastic, working above and beyond the call of duty. This will create a lot of extra pressure but we hope the public will be patient."
As well as creating extra wards, the Ulster Hospital has also created 48 new nursing posts. While this is a positive move, the hospital's management confirmed this figure brought their numbers up to the required level.
Whether or not the closure of the City Hospital's A&E is really temporary differs depending on who you talk to.
While management insist it is temporary, health unions argue differently. But with the South Eastern Health trust spending £3.5m on this so-called temporary arrangement, some might question if that is money well spent.