The new boss of BMI Healthcare, Britain's biggest private hospitals group, has begun wielding the axe and is understood to have notified hundreds of staff that their positions will be made redundant over the coming months.
Chief executive Jill Watts, who took up the reins in November, is embarking on a major restructuring of the firm that will also see the amount of NHS work BMI does ramped up.
Sources close to the company, which employs 9,000 across 63 hospitals, told IBTimes UK that Watts is also restructuring the board in order to "completely change the direction of BMI".
Currently, 35% of the group's work comes from the NHS but insiders believe this could double under her tenure. Watts oversaw a similarly NHS-focused operation when she headed up rival Ramsay Health Care.
Senior sources within BMI have raised concerns that a "dependency" on the NHS, while driving up volumes, could see margins plummet.
Last year BMI reported a 5.4% increase in earnings to £194m. However, BMI's hospitals, which were hived off into a separate property company by parent firm General Healthcare Group, have fallen into the hands of hedge funds KKR, DE Shaw and Centerbridge.
The property arm, to which BMI pays rent, is saddled with over £2bn of debt.
BMI declined to comment.