LONDON (Reuters) - The NHS faces a shortage of nurses and family doctors over the next four years, according to a leaked government planning document seen by the Health Service Journal.

The draft of the NHS pay and workforce strategy for 2008-11 also predicts an oversupply of 3,200 hospital consultants, the medical weekly reported on Thursday.

The document, written in November for the Department of Health's December board meeting, suggests creating "more cost-effective" sub-consultant roles to deal with the surplus.

But it acknowledges such a move would be "bitterly opposed by the British Medical Association", which represents doctors.

The draft also discusses ways of bringing down the national NHS pay bill between the financial years 2008/9 and 2010/11.

Nurses' wages could be set at regional rather than national rates, it suggests, although it concedes that staff unions would be unlikely to accept such a proposal without other concessions.

The document forecasts by 2010 the NHS will need 14,000 more nurses and 1,200 extra family doctors, and proposes more doctors could be encouraged to train as GPs instead of specialists.

A final version of the paper will feed into Chancellor Gordon Brown's comprehensive spending review this summer.

The draft says the outlook for NHS staff numbers is "very volatile", with the workforce dropping 2.7 percent this year.

Conservative health spokesman Andrew Lansley said such a drop would mean a fall of almost 37,000 jobs this year.

The Conservatives say the NHS lost 20,000 jobs last year as hospitals cut back to balance their books, although the government says there were only 900 compulsory redundancies.

Health Secretary Patricia Hewitt, who was heckled at a nurses conference last year, has promised the NHS will balance its books this year after a 512 million deficit in 2005/6.

"YO-YO" ATTITUDE TO PLANNING

The Royal College of Nursing (RCN) said the leaked draft demonstrated the government's "yo-yo" attitude to workforce planning.

"Just a few weeks ago, the secretary of state for health told MPs that the NHS had employed too many nurses but now her department has evidence predicting a shortage of 14,000 nurses within the next four years," said RCN director Janet Davies.

The British Medical Association (BMA) said it was "absurd" to suggest the NHS needed fewer hospital consultants.

"The NHS needs more consultants, not less, if it is to sustain lower waiting times and protect patient care in the future," said Jonathan Fielden, chairman of the BMA's consultants' committee.

"Patients deserve the best possible care, not a dumbed-down service based around a sub-consultant grade."

The Department of Health said it was only "prudent and sensible" to analyse the future workforce level of the NHS.

"To portray a responsible piece of planning as another 'crisis for the NHS' story is alarmist mischief-making on a grand scale," a spokesman for the department said.

He said growth in NHS funding was expected to return to more usual levels after the "huge amounts of money" the government had invested in the last few years.

There had been significant staff rises, with almost 18,000 extra nurses and more than 2,400 family doctors recruited to the NHS in the two years to September 2005, the spokesman said.