Doctors and nurses who hold management roles are among nearly 50 staff at Wellington Hospital waiting to hear if they have lost their jobs.

A hundred back-office jobs at Auckland and Waitemata District Health Boards have already been disestablished since late last year, with unions warning that clinical staff could find themselves picking up the paperwork.

Staff at Capital and Coast District Health Board were told last week of a proposal to trim 49 management and administration roles, including the board's entire human resources unit.

Some new positions will be created, but at least 18 people will be left without a job if the proposal goes ahead.

Some of the positions to go are management roles held by senior doctors and nurses, who also work part-time in frontline positions.

One staff member whose job is set to go said staff were "shocked and surprised" by the proposal. "Some of them had been through restructuring before so they were not happy."

Clinicians were likely to be affected by the loss of administration and management staff, the employee said. "It depends on how they [the board] handle it, but there will be staff affected even if they're not directly involved."

Nurses' Organisation spokeswoman Glenda Alexander said the plan to cut the number of nurse and doctor managers was quite worrying. "Any signalling of the disestablishment of frontline positions makes us nervous."

A Waitemata board spokeswoman said eight people there had been made redundant, with other affected staff members filling existing vacancies at the board.

Auckland District Health Board did not respond to a request for comment.

Ian Powell, director of the Association of Salaried Medical Specialists, the senior doctors' union, said that, although no clinical staff were being cut, he was worried the changes could make their jobs harder. "Most of the time those so-called back-room positions actually help clinicians to do their work."

Capital and Coast chief operating officer Shaun Drummond said clinical staff would not be left with more administration duties as a result of the changes.

Wherever possible, doctor and nurse managers would be given fulltime clinical jobs.

The proposal would help to relieve financial strain on the organisation, he said.

"We are facing a $47 million deficit this financial year and we need to find ways to address that."

Restructuring would save $2m a year. "Provided these gains are achieved, further radical restructuring should be unnecessary."

Health Minister Tony Ryall said last year that he expected district health boards to cut 300 back-office jobs during the next five years as part of Government reforms to streamline the health system.