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Some of England's best-performing hospitals could close and "many thousands of jobs" may go as the NHS struggles with "unprecedented" cuts, health trust leaders have warned.summer fashion 2011

The Foundation Trust Network, which represents about 200 top hospital groups, has warned in a letter to the deputy chief executive of the NHS that, despite claims that hospitals should expect to make savings of 4% next year, in reality many have been forced to squeeze budgets by an average of 6.3%. This represents £644m this year alone. At such a level, a big teaching hospital such as Sheffield would need to make £50m cuts next year.

"For many organisations this means serious financial stress that will lead to the loss of many thousands of jobs and will seriously endanger waiting times and services for vulnerable patients, as well as threatening organisational survival," wrote Sue Slipman, director of the Foundation Trust Network.

Speaking to the Guardian, Slipman said the NHS accepted it had to make efficiency savings of £20bn over four years, but added that the government was also capping payments to hospitals and penalising trusts if patients were readmitted. "The effect in some hospitals is they are facing cuts of 15% next year … it is the policy of unintended consequences."

In London, the Chelsea and Westminster hospital will need to make savings of 10%, amounting to over £22m next year. Guy's and St Thomas's is looking to save £53m, while South London Healthcare needs to cut £50m and the Royal Free and North West London trusts will each slash spending by £40m.

Slipman called for the government to limit the savings to 4% next year. "What [foundation trusts] are being asked to do goes beyond what efficient [hospitals] are able to deliver," she said.guess purses

There is also concern that ordinary hospitals, which struggled when the NHS was relatively awash with cash, will be unable to become foundation trusts, as the government wants, at a time of deep cuts. The Department of Health has identified seven such hospitals, including Portsmouth, Trafford and Whipps Cross.

Nigel Edwards, of the NHS Confederation, said: "It is not yet clear what will happen to any individual organisation. It is very important that we have clarity so that these changes can be made in a planned way, with as little disruption to patients as possible."

Labour's health spokeswoman, Emily Thornberry, said the government had claimed it would save services when in opposition, only to cut back once in office.

Simon Burns, the health minister, said the government "wanted to drive up the quality of services. Doctors know that better care can cost less and we can use the tariff to incentivise better, more efficient care for patients."

But a survey of family doctors reveals that patients in England face increasing rationing of healthcare in the next few years as a result of the government's NHS shake-up. A survey of 800 family doctors, by the Nuffield Trust health thinktank, found that 71% expect the switch to GP-led commissioning of healthcare will force new consortiums of doctors to focus on controlling their costs, which will lead to growing restrictions on juicy couture swimweartreatments the NHS can provide, limit the number and type of procedures patients can have, and offer less choice.

• This article was amended on 9 March 2011. In the original the Foundation Trust Network was said to represent 136 hospital groups. This has been corrected.