Four Birmingham public health chiefs earning a total of up to £500,000 per year are to see their jobs merged into one.
Last year the directors were overseeing public health issues for the city. Two were earning six-figure salaries and were on more than Prime Minister David Cameron.
Now bosses at Birmingham and Solihull NHS Cluster say changes are under way to employ just one director of public health for Birmingham from this year.
The four directors in place last year were Dr Jacky Chambers, for Heart of Birmingham Primary Care Trust (PCT); Dr Chris Spencer Jones, for South Birmingham PCT; Nicola Benge, for Birmingham East and North PCT and Jim McManus, employed by Birmingham City Council.
Dr Chambers, who has now retired, and Dr Spencer Jones, both picked up wages in the £145,000 to £150,000 salary band – more than Mr Cameron, who is paid £142,500.
Miss Benge earned £95,000 to £100,000, while Mr McManus was taking home an annual salary of £85,000 to £89,999.
All the wages were paid from the public purse by the NHS or local authority.
Denise McLellan, chief executive of Birmingham Cluster, said that an appointment process was under way to have a director in place for the “prestigious role” by March.
She added that the changes were prompted by the NHS reforms that were changing public health.
Miss McLellan reported to board members that Birmingham faced a considerable public health challenge.
Life expectancy is lower than the England average, while more people under the age of 75 are dying from coronary heart disease. Infant mortality, childhood obesity and mental health admissions are all higher than the national average, she added.
Public health involves preventing disease and prolonging life. Issues falling under its remit range from smoking and teenage pregnancy to infections, flu and other outbreaks.