The only way to avoid the scale of NHS job cuts outlined by McKinsey is to radically reform where and how NHS staff work, according to consultants Tribal.

The NHS should rapidly shift patients out of hospital and into their own homes under proposals now in preparation.

Tribal’s managing director Matthew Swindells said there would need to be much more multiskilling and staff treating patients in the community.

“Integration is an important part of the picture of getting a shared response - primary care trusts and foundation trusts sharing an interest in reducing admissions and managing patients in their own homes.

“We’ve been talking about doing that for 10 years but if the NHS doesn’t do it in the next five then there really will be job cuts like those outlined in McKinsey,” he said.

Mr Swindells said the £20bn saving figure referred to did not need to be a cash cut but rather “£20bn of growth [the NHS] wouldn’t otherwise get”.

Therefore it need not be essential to cut jobs to make cashable savings.

But he said: “I find it very hard to imagine that numbers of people working in the NHS won’t be very different in five years’ time.”

HSJ is holding a conference on “NHS Quality v UK Economy” on 6 October in London. For details visit www.hsj-quality.com