The National Health Service is set to shed more than 36,000 jobs this year before facing "very volatile" changes in its workforce that could leave it with thousands more hospital consultants than it can afford to employ, according to a leaked document from the Department of Health.

At the same time, however, big cuts in nurse and medical training budgets last year and this year could mean the service will be short of 14,000 nurses, 1,200 family doctors and 1,100 junior hospital staff by 2011.