Hammersmith and Central Middlesex A&E departments close
Two hospital accident and emergency units in London have closed.
Hammersmith and Central Middlesex A&E units are being replaced with 24-hour urgent care centres (UCCs), which generally care for walk-in patients.
Patients requiring an ambulance will have to go to either St Mary's in Paddington, Northwick Park, Charing Cross or Ealing hospitals.
However, Charing Cross and Ealing's A&E futures are also being reviewed. Northwick is soon to open a £21m A&E.
Earlier protesters stood outside Hammersmith hospital with placards opposing the changes.
Hospital campaigner Gloria Wildman said: "I'm really, really upset. This shouldn't be happening.
"This is 21st century Britain, this is a rich country and what about the poor people? We matter and I'm really, really angry."
Under its plans, titled Shaping a healthier future, the government wants to have fewer but bigger A&Es in north-west London.
Dr Ruth Brown from Imperial College Healthcare Trust said: "It's not financially driven, it's driven by the need to consolidate emergency and urgent care services and provide the best possible care.
"We know from, for example, the major trauma centre, where our outcomes are one of the best in the country, that if you consolidate your specialist services you get much better outcomes for patients."
The Northwick Park unit is set to have more staff when it is opened later this year and the old unit will provide extra beds to help cope with the greater demands following the closures of Hammersmith and Central Middlesex.
In August, a Care Quality Commission report said Northwick Park "required improvement" and patients were being discharged too early because of the patient flow through its A&E department.
Imperial College Healthcare NHS Trust said St Mary's now had extra staff and assessment bays, as well as a new 15-bed elderly care ward and four extra surgical beds. It said Charing Cross had also expanded its capacity.
But an NHS report, published in May, said St Mary's Hospital A&E was at "maximum capacity".
Patients suspected of having a heart attack will continue to be taken to Hammersmith - one of London's eight heart attack centres.
Labour members of the London Assembly said the government was "blindly pushing through flawed closures".
Dr Onkar Sahota said: "This level of A&E closures is unprecedented and amounts to a policy experiment with no safety measures.
"We cannot go ahead with any changes, especially when good hospital A&E units are set to close, and one already identified as in need of improvement [Northwick Park] will be asked to pick up the slack."
Andy Slaughter, Labour MP for Hammersmith and shadow justice minister, who has long campaigned against hospital changes, said: "A&Es are already at capacity and the thought that two will close immediately and another two - Charing Cross and Ealing - within the next few years is grotesque."
Dr Ruth Brown, chief of service and consultant in emergency medicine at the trust, said: "We can provide better care, more sustainably, by concentrating more resources for seriously ill and injured patients at St Mary's Hospital and Charing Cross Hospital."