GPs in Co Meath have been told that ambulances will partially bypass Our Lady's Hospital in Navan in a two-phase transformation of emergency services from December 12th.
The letter was issued by the HSE Local Integrated Care Committee and says the second phase will take place early next year.
The first phase was signed off by the Health Minister Stephen Donnelly last Friday, but the second phase has yet to be politically approved.
It's understood the planned Medical Assessment Unit (MAU) service will no longer be GP referral led as originally proposed, but will have its own triage team which will take pressure off GP services.
The letter states: "There will be a partial ambulance bypass of Our Lady's Hospital, Navan, from the 12th December. This is phase one of transformation. Confirmation of phase one by the Minister of Health only happened last Friday 25th November.
"From this date ambulances will no longer take very high acuity illness which will likely map to Manchester Triage Category 1 and 2 to Our Lady's Hospital Navan. The ambulance bypass will also be for patients with acute abdominal pain.
"All other ambulances will continue to bring patients, as before, to Our Lady's Hospital.
"Separate to transformation, the Medical Assessment Unit will reopen on Thursday 1st December. Referral will be by letter and phone-call, as in pre-Covid days.
"This system will remain until phase two of transformation occurs."
The letter says that a meeting by the Local Intergrated Care Committee next Tuesday will have "an altered agenda and will now centre around updating attendees about the current status of transformation of OLHN, with Qs and As".
The HSE is to run a public communication campaign to reassure the public that the hospital is not closing, and that over 80 per cent of all patients and over 90 per cent of medical patients who currently attend Navan will still be able to have their medical needs met.
The letter is signed by Dr Niall Maguire, Dr Catherine Wann and Dr Deborah Ryan.
However, while the hospital won't be closing, Cathaoirleach of the Save Navan Hospital Campaign said the A&E services will effectively be no more.
"This is scandalous news. More than 100,000 patients have gone without beds in Irish hospitals so far this year," said Peadar Tóibín.
"It is absolutely incredible that at the height of the winter surge on our A&Es, when pressure on Navan and Drogheda A&Es is literately out the door, when corridors are full of patients for the lack of capacity and space and when staff are leaving Ireland because of the pressure that they are under, that the HSE would seek to redirect Ambulances from Navan to Drogheda.
How can HSE management be so detached from the experience of ordinary patients? This will shift dozens of patients every day into the chaos that is Drogheda Hospital. We are looking at University Hospital Limerick mark two.
While the HSE letter states that most patients will still be treated in Navan even after the A&E closure, Mr Tóibín has stated "figures produced by the HSE’s own data systems show that an extra 45 patients a day would have to travel to Drogheda to attend the A&E".
"This will enormously increase the pressure on Drogheda Hospital.
"We understand the ambulance divert plan is timed to coincide with the cabinet reshuffle and the potential move of Stephen Donnelly. It also coincides with the most senior Minister in Meath Helen McEntee going on maternity leave and at a time when we have no CEO of the HSE.
"It's a deeply cynical anti-democratic move and the Minister for Health must publicly put a stop to it now," he said.