Day by day, the hope that frontline NHS services would somehow remain magically untouched by the coalition's austerity drive is revealed as a fantasy. The problem for David Cameron and his health secretary, Andrew Lansley, though, is their repeated promises – in opposition and in government – that the NHS was different, its budget would be ringfenced and that care would be maintained. That was encapsulated in the prime minister's clear pledge that "We'll cut the deficit, not the NHS". But what was politically useful then is becoming politically perilous now.

A survey of its members carried out by Doctors.net.uk reveals that four out of five GPs and hospital doctors have seen cuts to staff or services in their own part of the NHS in the last year. It was a small sample, just 664 respondents; and it was self-selecting, which tends to skew any poll towards the malcontented, and thus exaggerate the negative. But key organisations working at or near the frontline agree that the findings give a broadly accurate picture of the emerging reality in the NHS.

In Surrey and Hampshire dozens of children with ME or chronic fatigue syndrome are preparing to lose the support of a consultant and a nurse specialising in that condition, as both the Frimley-based health professionals are not being replaced. In Lewisham, south London, almost £500,000 has been chopped in this financial year from the budget for children's mental health services. In Camden, north London, doubt surrounds the future of the InterAct Reading Services charity, which gets actors to read stories to hospital patients to help their rehabilitation, because local primary care trusts (PCTs) – which are being abolished in April 2013 as part of the coalition's NHS shake-up – have reduced or withdrawn funding ahead of their disappearance.

NHS-funded public health observatories in London, the north-west and the north-east – which are not scheduled to close – are nevertheless also at risk, says the Commons health select committee.

Some PCTs have reduced the amount of Viagra they will supply to men with erectile dysfunction. In Lambeth, south London, the PCT has cut the number of patients eligible to receive free incontinence pads, reports Dr Clare Gerada, a local GP and chair of the Royal College of GPs. Access to IVF, cataract removal or a new hip or knee has been tightened by dozens of PCTs. In addition, hospitals appear to be reducing the number of follow-up appointments they give patients suffering with rheumatic, skin or urology problems, as they too, like PCTs, seek to save money and contribute to the 'Nicholson challenge", which wants the NHS in England to make £20bn of efficiency savings by 2015.

In Ashford, Middlesex, Dr Peter Kandela, a local GP, tells his patients in his regular surgery bulletin of three different money-saving measures. Some patients have been switched from their usual medication to other branded drugs because the latter "are far cheaper and save the NHS money". GPs have also been told by the local PCT to stop issuing long-term repeat prescriptions and to hand out scripts for just two months supply of drugs instead, except for the pill. And lastly, "we have received notifications from the skin department at Ashford & St Peter's hospital that they would no longer accept referrals for benign moles, cysts, skin tags and other non-cancerous conditions. Workload is blamed for these decisions. Sadly, we shall no longer be able to make referrals for these conditions," Kandela explains.

These are not life-saving services, and indeed removal of unsightly but benign skin tags is arguably not what the NHS is there for anyway. But these services do aid patients' quality of life, boost their chance of recovering or enhance their mental health. Yet they are increasingly being deemed no longer affordable by NHS bosses.

Dr Mark Porter, chairman of the British Medical Association's hospital consultants committee, says: "Things like orthopaedic surgery, eye surgery and IVF are not even debatable in the way that tattoo removal might be. There's an ethical debate to be had about [cutting] some things, but not about things like knee pain and back pain, which can be offered to patients but we are choosing not to."

No wonder private health providers are starting to see an increase in the number of people prepared to pay for rapid treatment of conditions that their local NHS deemed unnecessary or not an urgent priority.

It is hard to avoid Porter's conclusion that, once the tens of thousands of ongoing job losses are factored in too, that the NHS is "retracting" or being slowly downsized. Or that of the Patients Association chief executive, Katherine Murphy, when she points out that, amid growing cuts, no one is being honest about what the NHS can and cannot afford. So we need a grown-up debate about that. Growing demand for healthcare in an era of tight public finances makes that inevitable. Something has to give; indeed, things are giving already. The NHS top brass and Lansley have so far simply castigated NHS organisations for making such decisions. But a national conversation about which patients should win and lose does not make for attractive politics.