The Scottish NHS will struggle to make £200m of planned “efficiency savings” next year without services being hit, a watchdog report said today.

Audit Scotland said public spending this year will reach a peak, with reductions expected over the next five years.

The report found that the NHS’s financial performance in 2008-09 had been good, with its £10bn budget showing an underspend of £4m.

But it added: “NHS bodies have forecast that they will need to make more than £175m in recurring and £25m in non-recurring efficiency savings.

“This presents a significant challenge for many NHS bodies and their auditors have stated that it will be difficult for some to achieve the required level of savings without any negative impact on the services they provide.”

Dr Brian Keighley, who chairs the British Medical Association in Scotland, warned of a “real-terms” reduction in funding for NHS services in coming years.

“The drive to meet targets for 2 per cent efficiency savings will become increasingly difficult. Government must protect frontline health services to ensure that funding cuts will not impact on patient care,” he said.

Health secretary Nicola Sturgeon said next year’s Scottish Budget would see health spending rise to £11.347bn.

But she added: “There’s no doubt that the entire public sector faces a challenging climate ahead.”