West Midlands NHS trusts with debts totalling more than £16 million are considering 1,200 job cuts to combat their financial health crisis.
In a letter to the chief executives of the 23 trusts, the Birmingham and Black Country Strategic Health Authority has suggested a freeze on the replacement of, among others, nursing and administrative staff. Frontline medical posts, including GPs, consultants and doctors, would not be affected.
The SHA letter reveals that the non-replacement policy could help the trusts claw back up to £11 million.
Last night it emerged that similar measures are being considered by the Shropshire and Staffordshire Strategic Health Authority, which is looking to lose 480 jobs.
Shrewsbury and Telford Hospital NHS Trust alone has estimated debts of £10 million this year and historic debts of more than £19 million.
More than 52,000 people are employed across the West Midlands' acute and primary care trusts, of which 38,000 are categorised as nonmedical. The estimated annual turnover of staff is 11.5 per cent.
Under the proposed measures, medical vacancies would be filled, but only 70 per cent of nursing posts replaced - with a freeze on agency staff - and just 20 per cent recruitment for vacant administrative roles.
The letter to the trusts recognises they face "significant financial pressures" but points out that their books must be balanced by the end of this financial year.
Cynthia Bowers, managing director of the SHA, said the document set out different ways to achieve financial balance.
"What we are suggesting to our organisations is not a response to any perceived NHS crisis but a continuation to our role in helping organisations to operate more successfully in the new NHS," she said.
" Birmingham and the Black Country Strategic Health Authority has written to all hospitals and primary care trusts, to suggest ways of working more effectively.
"The letter set out a number of examples of how financial savings and better ways of working might be achieved. The workforce numbers mentioned do not mean that anyone currently working in local health services will lose their job. The figures cited as an example are based on a planned evaluation of what non-medical posts need to be replaced when they become vacant.
"As in previous years, Birmingham and The Black Country fully expect to meet financial balance."
The SHA is one of 28 created in England in 2002 to manage the NHS. It covers Birmingham, Dudley, Sandwell, Solihull, Walsall and Wolverhampton and oversees the trusts which provide primary care, hospital, mental health and ambulance services.
The £16 million deficit was the figure recorded at the end of September.
A spokeswoman for the SHA added: "No decisions have been made - we have asked organisations to submit their plans for the opportunities that the letter might bring to work more effectively, and we will be meeting with all trusts and PCTs to discuss their plans.
"We will be meeting with each trust on a one-to-one basis over the coming weeks to help identify the best way forward for them to achieve financial balance."