Residents have often protested about plans to withdraw services
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Grantham hospital's maternity unit is again under threat after health managers published proposals for the future of healthcare in Lincolnshire.
The county's primary care trust says midwifery-led services in Grantham will be reviewed 18 months after a consultation period has ended.
But 300 more babies need to be delivered there each year to make the service sustainable.
The public have until 9 August to make their views on the proposals known.
In February and March the PCT held a series of workshops involving more than 500 people from a range of organisations.
Now a document called Shaping Health for Lincolnshire has been prepared which lays down key points.
Proposals include ending emergency general surgery at Grantham which will be undertaken only at Lincoln and Boston; and creating a network of accident and emergency departments, with urgent care services at Mablethorpe being improved.
PCT chairman Richard Childs said: "The PCT will not make any decisions on the issues set out in the consultation document until all the responses and feedback have been considered."
Services at Grantham have been under threat for some time.
Up to 8,000 people are thought to have gone on a protest march in September 2006 against planned changes to the town's emergency and maternity services.
Residents were opposed to a turnaround plan by United Lincolnshire Hospitals NHS Trust which was trying to overturn a multi-million pound overspend.