NHS managers are planning to axe GP physiotherapy services, hearing aids and vasectomies - instead telling patients to go private, a document reveals.
The Mid Essex Clinical Commissioning Group, which already severely restricts access to IVF, is planning to save £15.7 million through drastic cuts to NHS services.
It is holding a consultation on ways to save cash, including stopping prescriptions for gluten-free foods, axing hearing aids for people with mild hearing loss and stopping female sterilisation.
It says patients can go private instead or buy items on the "high street", whilst women wanting sterilisation should opt for other "low risk" forms of contraception.
The CCG looks after the health of 389,000 NHS patients in Maldon, Braintree and Chelmsford. It is proposing the rationing as it "needs to make savings".
It proposes cutting the £1.16 million it spends on hearing aids for mild hearing loss by £335,000, saying they are available for patients to buy for £500 to £2,800 in places such as Specsavers.
It said many people are prescribed hearing aids but do not wear them, adding they are widely available on the "high street".
When it comes to vasectomies, the CCG said it spends £356,600 a year but argues people can get them privately for a cost of £295 to £1,167.
It said "at least three" private clinics in Essex offer vasectomies, saying it wants to stop routinely funding them and female sterilisation.
It said: "Vasectomies can be accessed privately and relatively cheaply" and "effective low-risk alternative methods of NHS-funded contraception is available for women".
The CCG also wants to restrict GP-accessed physiotherapy services for musculoskeletal problems, and suggests three options.
Option one is to tell patients to go private instead, saving £1 million, giving people "telephone advice only", saving £825,000, or limiting the service to one assessment and one follow-up appointment, saving £600,000.
It argues waiting times would be cut by the last two options, that evidence shows not all patients benefit from physiotherapy and that there would be fewer "unnecessary" follow-up appointments.
It also said evidence shows that "early advice on self-management is an effective intervention".
In another area, the consultation document says the CCG spends £100 million on gluten-free foods for people with gluten intolerance and coeliac disease - where people can have a severe reaction to gluten.
It said these foods are available "online at Tesco, Asda, Morrisons, Sainsbury's Waitrose, Ocado" and all major supermarkets, and is planning on stopping prescriptions for these items altogether.
It argues that it costs the NHS more to buy gluten-free products than in supermarkets, and that other patients, such as those with lactose intolerance or diabetes, do not get access to free foods on prescription.
Natalie Beswetherick, director of practice and development at the Chartered Society of Physiotherapy, said: "We appreciate the financial situation this CCG faces but quite simply, these proposals cannot go ahead.
"They are all completely unacceptable and would do enormous damage to patient care in that area.
"Tens of thousands of people would be left without access to the specialist help they need to recover from injury or manage a long-term condition and it is outrageous to suggest they could just pay for it instead - the NHS must remain available for all who need it."
She added: "The intention is to save money, but removing the (physiotherapy) service will force some patients to revisit their GP, while others will end up needing surgery at a far greater cost to the NHS.
"So this isn't even robbing Peter to pay Paul; under these proposals, both Peter and Paul will be out of pocket.
"The commissioners must abandon their proposals and take up our offer to work with the service to implement changes - such as direct access to physio without needing to see the GP first - which will save greater sums of money but in a way that works for patients."
Action on Hearing Loss chief executive Paul Breckell said the CCG should follow its neighbour, North East Essex CCG, in abandoning the plans.
He said: "Costing the NHS only £90 each, hearing aids are the only tangible and cost-effective treatment for mild hearing loss and they keep people in work and offer a lifeline to many who would otherwise be sat at home alone unable to communicate with the outside world.
"We are urging Mid Essex CCG to abandon its own plans, which are currently under consultation, to restrict hearing aids for people with mild hearing loss and follow the decision made by their neighbouring CCG."