NHS Grampian needs to make more than £70 million of cuts over the next four years to balance the books.

The workforce plan for 2018-2021, to be presented to the board today, also reveals the organisation has spent more than £37 million last year on expensive agency and bank medical staff as they continue to battle to fill historic employment holes.

However, the spend on temporary staff is reducing and last year’s figure was down from £40.3 million in 2016/17 – and they hope to reduce that further to help with the drastic savings.

The report adds that to maintain “financial balance”, £18.3 million will need to be shaved this financial year, and a “similar level of savings” would be required for the three years following that.

The key areas the health board will look at are reducing medical locums, making savings on the cost of medicines and investigating “service and productive efficiencies.”

It comes as the health board revealed that nursing, medical staff and allied health professionals – which includes roles like radiographers, physiotherapists and podiatrists – have had vacancies of more than three months.

The board’s workforce plan states: “This creates additional pressures on existing workforce and can create increased reliance on supplementary staff”.

The plan also highlights a 20% turnover rate within senior management, the highest across the local service. With personal and social care next at 13.25%.

Last night, an NHS spokeswoman said the plan this year was to further reduce the cost of locums and on medicines.

Martin McKay of the Unison union said that most of the requirements for temporary were due to “historic underfunding” and that the north-east didn’t have the same “body of population” to recruit from as other areas in the country.

But he added: “Any savings that have to be made can’t be at the risk of safety, either to patients or existing staff.

“NHS Grampian has previously achieved a balanced budget but that doesn’t mean we are complacent. We will not stand for safety being undermined.”

Aberdeenshire West Conservative MSP Alexander Burnett said: “These figures once again demonstrate the financial straitjacket within which NHS Grampian has to operate.”

And North East Labour MSP Lewis Macdonald added: “The budget for NHS Grampian has not met the increasing demands that are being put on the board.

In June, Audit Scotland’s 2017/18 draft report praised the health board for its “effective” financial arrangements, but also found it failed to meet 16 out of 19 of its key Local Delivery Plan (LDP) targets.

Fears have also been raised about the imminent departure of chief executive Malcolm Wright who is widely credited for turning around the health board since he took on the role in 2015.

In recent months he had also been parachuted in to bail out crisis-hit NHS Tayside after it became embroiled in a major financial scandal.

An NHS Grampian spokeswoman said: “The board is confident that expenditure on medical locums will be reduced over the next year as appointments have been made to a number of consultant posts which were previously covered by locums.

“There is the likelihood that agency nursing spend will increase in the short term in order to ensure continuity of safe staffing levels and to support a number of key service delivery initiatives.

“In the longer term the board expects agency nursing spend to reduce as a number of workforce redesign plans have been developed and are currently being implemented.

“Supplementary staff provide a vital short term support and there will always be some requirement for this type of cover in Grampian.

“However, our preference is to recruit permanently and we continue to work hard at filling our vacancies. The provision of a safe and sustainable service for our patients and staff will always be the major consideration whenever we consider reducing our spend on supplementary staffing.

“The main areas which will be targeted for achievement of savings in 2018/19 are medical locums, savings on the cost of medicines and savings delivered through service and productive efficiencies.”