Far-reaching reforms of hospitals and working practices have been recommended in a report on the future of the NHS in Scotland.
Specialist hospitals will deal with major surgery
A group led by top cancer specialist Professor David Kerr has published a 60-page study for ministers.
Under the recommendations, patients will have to travel to specialist hospitals for most surgery.
A new network of community hospitals will also see treatment delivered by GPs, nurses and paramedics.
Prof Kerr stressed the importance of local services as he unveiled the 20-year plan for the NHS.
"We need to focus on getting the right services out in the community rather than on the bricks and mortar of hospital buildings," he said.
"We want to see much more regional planning for hospital-based services, with new networks of hospitals sharing the responsibility for providing key elements of acute care."
The biggest changes will be to focus highly specialised treatment - like heart by-pass surgery and neurosurgery - in a few centres of excellence.
More minor elective surgery and more serious accident and emergency treatment will be performed in a network of regional hospitals, with patients travelling for treatment.
But about two-thirds of urgent treatment, the area of most public concern according to the professor, will be provided at local hospitals by "community casualty units" comprising GPs, nurse practitioners and paramedics, instead of consultants.
The report said in future day surgery should be treated "as the norm" rather than inpatient surgery.
This approach may mean "a relatively small number of people who might have had emergency surgery in one hospital may in the future have to travel a bit further".
But it added that the numbers involved are "relatively small in comparison to those who will get their daily care needs met in a community setting".
However, the professor also warned that the programme of hospital downgrading, particularly in central Scotland, would continue.
Prof Kerr (centre) and Health Minister Andy Kerr meeting NHS staff
Health Minister Andy Kerr told Holyrood the recommendations were a bold and confident plan.
But he warned health boards: "A take-it-or-leave-it approach won't do.
"I expect people to be consulted about the case for change and the options for change, long before a preferred solution is reached."
He said priority would be given to identifying patients with long-term conditions who were at most risk of hospitalisation, so boards could provide them with "personal, proactive co-ordinated care" locally.
"We will ensure that each NHS board adopts a systematic approach to providing that care," Mr Kerr added.
The expert group began its review, which took evidence from doctors, patients and communities, in November last year.
Prof Kerr, who was born in Glasgow, was appointed to head the group amid local protests against the downgrading and closure of accident and emergency and maternity units across the country.
He told BBC Scotland that the town hall meetings which had been held in different areas to gather the public's views had been one of the most important parts of the process.
"There was a very strong message coming across from the people of Scotland that they wanted services local," he said.
Dr Peter Terry, chairman of the BMA in Scotland, said: "This report prescribes some of the treatments that could potentially cure the ills of the NHS and improve the Scottish health service for the benefit of its patients."
He added: "It is vital that patients across Scotland in rural and urban communities have access to essential health services.
"However, all services must be safe for patients and doctors and provide recognised standards of care."
Scottish National Party health spokeswoman Shona Robison said: "The report vindicates the campaign to keep health services local but the health minister has failed to say whether any of the services currently under threat will be reprieved as a result.
"Local hospital campaigners will welcome the broad thrust of Professor Kerr's report but will condemn the health minister's refusal to take any action to stop unnecessary centralisation of hospital services."
Dr Nanette Milne, the Scottish Tory health spokeswoman, welcomed the report but called for swift action guarantees on delivery.
She said: "Localised services need a local team and the problems with staffing levels in the NHS today do not inspire confidence in the ability to provide them."
Local government body Unison said it was pleased the report had ignored lobbying for increased private sector involvement in the NHS.
But it urged no restructuring of the NHS for at least five years to allow stability.