Health managers in Pembrokeshire have warned patients may face "significant changes" in services, as they face up to budget problems and other pressures.
Health officials say loan repayments of £8.2m will add to problems
A joint report from Pembrokeshire and Derwen NHS Trust and the local health board said they face a £2.4m budget shortfall for the next year.
This is set against a background of staff shortages, new contracts and modernisation and changes in the NHS.
A review of hospital acute services for mid and west Wales is in the pipeline.
The trust discussed the issue on Thursday, with a joint report issued with the local health board at the end of last week.
Problems faced by health services in Pembrokeshire include:
- The cost of employing locum doctors and agency nurses is running at £2m a year
- Additional savings of £3m are needed and officials say central NHS funding is 3% less than costs
- Loan repayments of more than £8m also need to be made over the next three years
- 13 consultants posts are 'very difficult to fill' and there are 21 nursing vacancies
"Within our current funding shortfall, it is costing us too much money to 'patch over' the enduring and current recruitment difficulties," said the report.
New consultant contracts have led to the trust bringing in more visiting locums for treating outpatients, which in one speciality alone could lead to an extra £500,000 in costs this year.
Where consultants are unavailable, outpatients may need to travel to clinics in Carmarthen, Swansea and Cardiff.
The report admits that some current hospital services in the county may be provided in the community or outside specialist units in future.
As part of the regional acute services review, the report said long term consultant vacancies would be a starting point and "we can and should anticipate some radical service proposals".
Geoff Wright, chairman of Pembrokeshire Community Health Council said the initial outline given by the trust was "provisional in the extreme" and that the response should be "strategic and measured in terms of its effect on patients".
Meetings with health watchdogs in the area are expected to continue over the next few weeks.