Thousands of doctors qualified to become consultants could face unemployment instead, the NHS says.

A leaked copy of the Government’s pay and workforce strategy reveals that by 2011 there will be 3,200 more consultants than there are jobs. It suggests that they will be employed in more junior roles at lower salaries, a move bitterly opposed by the British Medical Association.

The document, leaked to the Health Service Journal (HSJ), also suggests that by 2011 there will be a shortage of 14,000 nurses and 1,200 GPs, while there will be a surplus of 16,200 physiotherapists, healthcare scientists and technicians.

The document, discussed by the NHS board at its meeting last month, indicates that training programmes and actual demand for staff are seriously out of kilter. It suggests that the era of guaranteed jobs for doctors is over, with a new, fluid market emerging and unemployment being used to drive down salaries.

Cuts in the clinical excellence awards given to the best consultants are also suggested as a way of saving money.

The BMA reacted with anger to the proposals. Jonathan Fielden, the chairman of the BMA consultants’ committee, said: “It is absurd to suggest that the NHS in England needs fewer hospital consultants. NHS consultants have driven the massive cuts in waiting times and continue to deliver real improvements in patient care. To suggest that there should be fewer consultants, and of a lower grade, will destroy the gold standard of specialist care that patients rightly deserve.”

Workforce planning is one of the toughest tasks that the NHS faces. It takes at least 11 years to train a doctor to the level of consultant, which is marked by a certificate of completion of specialist training (CCST). Doctors with a CCST can apply for consultant jobs.

The document says that by 2011 there will be 3,200 doctors with CCSTs that the NHS “cannot afford to employ”. Increasing numbers now midway through their training will not be matched by a similar increase in posts.

Today there are 31,600 consultants, 200 more than the 31,400 posts. But the gap will swiftly widen. By 2010-11, demand is expected to be 32,700, while the supply will have reached 35,900.

By then there will be a shortage of junior and staff-grade hospital doctors amounting to 1,100, and 1,200 too few GPs. Overall there will be enough doctors, but they will be trained in the wrong ways for the jobs available.

In a free market, doctors would move to where the work was, or the excess supply of consultants would drive down salaries, enabling more to be employed. But the NHS is dominated by centrally negotiated contracts that allow little such flexibility.

In particular, the suggestion of a new “sub-consultant” grade is a red rag to the BMA. “Patients deserve the best possible care, not a dumbed-down service based around a sub- consultant grade,” Dr Fielden said. “Workforce planning in the NHS has for many years been woefully inadequate. The BMA has repeatedly tried to suggest improvements in workforce predictions to the Department of Health and NHS employers.”

The Government has already started to try to force down costs by proposing a below- inflation 1.5 per cent increase in pay and salaries to all NHS staff for next year.

In another paper leaked to the HSJ, a senior offical wrote of “a real danger of industrial unrest” if the rise were set below 2 per cent.

A spokesman for the Department of Health said: “Over the next few years the NHS needs to consolidate improvements in patient care, reduce waiting times to a maximum of 18 weeks, respond to patient demand for care closer to home and to become more efficient in its use of resources...it is therefore only sensible to analyse what the workforce make-up should be to meet those challenges.”

He added: “This work is at an early stage and the ideas in the paper are very much what any health expert would be expecting the department to be considering.”