Bosses, who have to save £20 million this year, have not ruled out the possibility of redundancies .
They insist the job losses will not affect frontline services, but union representatives say any cuts to back room positions will directly affect doctors and nurses.
Lesley Doherty, the chief executive of Bolton NHS Foundation Trust, told the Council of Governors that “at least 200 jobs” would be affected.
The announcement comes after an advertisement for a new chief operating officer at the hospital was posted on the NHS Jobs website.
The description states the job comes with a “significant six figure salary and benefits”.
Some of the 200 posts have already gone — when the laundry service and printing service were out-sourced earlier this year — and the hospital is hoping many will come from natural wastage — such as retirement.
A spokesman from the hospital has also said some staff will be re-deployed where possible into different jobs within the Royal Bolton.
The hospital has introduced a vacancy freeze for all but the most essential posts and has re-introduced MARS (Mutually Agreed Resignation Scheme), which staff can voluntarily make application to.
Ms Doherty said: “It would be wrong of me to say this will not affect jobs.
“There are at least 200 jobs that will be affected this year. As much as possible will be natural wastage. We will look at turnover. It will mean some posts going though.
“This is going to be tough times for this organisation as it is for the NHS. We are going to have to make some real decisions about health services across the NHS, not just Bolton.
“I don’t know what they are, but we can’t just keep making savings from the same place all the time.
“We are not looking to make any changes to our frontline nurse staffing.”
Unions say the hospital is down to its “bare minimum”.
Harry Hanley, branch secretary for Unison, said: “They are saying it won’t affect frontline staff but of course it will.
“Services will start to suffer. It will affect patient care.
“They can’t make those kind of savings without slashing services and I think some departments could close.
“They are going to have to make people redundant , they might disguise it as MARS, but one way or another, they will go and it is worrying.
“The staff don’t know what it happening. They don’t know if they have got a job tomorrow or next week — some of these people have worked here all their working lives and they are very stressed.”
In addition to the chief operating officer position, which is to replace Andrew Colgan who left earlier this year, the hospital has been required by health watchdog Monitor to appoint a Turnaround Director and external advisers.
Heather Edwards, head of communications at the hospital, said the board vacancy post and salary is “in line with other trusts of this size”.