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More than 250 nursing posts are being lost at a London NHS trust as it tries to meet the Government's demand for efficiency savings.
A total of 635 posts will go at Barts and The London NHS Trust, of which 200 will be lost through redundancy.
The rest will go due to measures such as staff being redeployed into other jobs and people not being replaced when they retire.
Trust officials said they hope the 200 redundancies will not be among nurses, although 258 nursing posts will definitely be lost in some way.
The Royal College of Nursing (RCN), which has has evidence of 27,000 job losses across the NHS, described the move as "outrageous".
The Government has told the NHS to find £15 billion to £20 billion in "efficiency savings" every year by 2013/14. The NHS budget currently tops £100 billion.
A statement from Barts and The London said: "Over the next few years, all hospitals are being asked to contribute to the 20% productivity improvement needed by the NHS, and Barts and The London is no exception.
"Delivering higher quality at lower cost is the only way we will achieve our ambition to deliver care to the highest international standards.
"To meet this challenge we have reviewed every aspect of our expenditure to ensure it is truly essential and represents best value.
"We are securing better deals from our suppliers, using wards, clinics and theatres more efficiently and reducing the amount of time patients have to spend in hospital. But around two-thirds of what we spend is on pay, so reducing our pay budget is an essential part of our overall cost reduction programme."