The document, by consultancy firm McKinsey, says a 10 per cent reduction in the workforce is necessary for the NHS to achieve its target of £20bn in efficiency savings.
Commissioned by the DoH, the report also suggests an early retirement programme for older GPs and community nurses, to make way for ‘new blood/talent'.
Health minister Mike O'Brien said the DoH has already rejected the proposals. ‘In core frontline services like maternity, nursing and primary care we need more staff rather than fewer,' he said.
RCN chief executive Dr Peter Carter said recommending more community nurses retire ‘demonstrates a very poor understanding of what is happening in the health service'.
‘A serious shortfall' in nurses was expected over the next decade already, said Dr Carter.
Nigel Edwards, director of policy at the NHS Confederation, described the report as ‘a sober analysis' but said it was possible to plan a reduction in headcount 'without massive redundancies,'as around people 30,000 retire from the NHS annually.