The strategy predicts an oversupply of the equivalent of 3,200 whole-time hospital consultants which the NHS will neither need nor be able to afford within four years. It suggests that the service will have an excess of 200 in the coming financial year, rising to at least 3,200 by the end of the next comprehensive spending review period, which ends in 2010-11.
The document is blunt: 'We are predicting an excess of medical specialists over the CSR period as a whole, which we cannot afford to employ as consultants.'
The main solution it offers is encouraging foundation trusts to create new sub-consultant roles for doctors who have received their certificate of specialist training. These 'are more cost effective than traditional consultant posts', it says.
Attempts to introduce such a grade have already met with major opposition: last year the BMA formally rejected proposals for such a grade.
The draft strategy warns that 'as a result of this opposition' and the fact that the BMA 'declined an opportunity to be involved in a collective solution to the problems of specialist over-supply in 2006', the government must lend 'strong support' to the creation of the sub-consultant grade to encourage foundation trusts to 'progress this agenda'.
The document outlines the government's fears that, left unchecked, the growth in NHS hospital consultant numbers will leave a massive funding gap and a huge number of unemployed consultants in four years' time.
'Reductions in funding training have not fed through to medical training yet, which continues to show a healthy growth,' the document says.
It continues: 'This suggests that, all other things being equal, present policies will continue to generate an oversupply in the medium to longer run.' However, it says that in the longer term the UK will need more specialist doctors, hence the need for 'a more affordable approach' to their recruitment.
The paper says: 'There is an increasing tension between a predicted rising long-term demand for doctors, taking into account population demography, and more immediate affordability issues. Failure to invest now produces welcome short-term savings but shortages in the longer term.'
It says there is little research to suggest that an oversupply of consultants would drive down wage levels, but suggests unit costs might be reduced either via the introduction of new sub-consultant grades, or by cutting the costs of doctors' clinical excellence awards. The document says the government is already 'planning to review the... system to reduce its unit costs and improve its incentive effects.'
But the paper warns that unless the government can find the resource to 'buy out' current contractual entitlements, new measures could only be applied to newly qualified doctors and would be 'unlikely to have a significant effect' given that doctors represent less than 25 per cent of the total NHS pay bill.