Yesterday he guaranteed that permanent nurses would keep their jobs and "contracts we have for temporary staff will be maintained".

An ongoing review of patient service needs, activity and staffing levels in multi-purpose services, community hospitals and other small health facilities attached to the 34 health services has prompted the health district to propose a reduction in nurse hours at some but not all of them.

Mr McLachlan reports of up to seven of the facilities needing more nurses and eight having the right level of staffing.

"We've found that there is definitely not equity in the staffing," he said.

"Staffing hasn't been changed in some cases in 10 to 15 years, even though activity in some facilities has changed significantly.

"This isn't about cuts to staffing. This is about equity and we are increasing staff levels where activity has increased."

The chief executive accepted a request for an interview with the Daily Liberal yesterday after the health district incurred the wrath of nurses in Nyngan and NSW Nurses and Midwives' Association organiser Darius Altman for suggesting a reduction of "14 clinical care hours a day" at the town's multi-purpose service.

"They cannot realistically keep up with current demand and they work overtime hours unpaid and through their meal breaks," Mr Altman said.

"This is cost-cutting and will have adverse outcomes for patients. They're placing money and budgets before the health of the community."

The union's research showed the "more nursing hours allocated for patients the better the outcome", the organiser said.

The health district's strategic plan has made staying within budget a priority, but Mr McLachlan yesterday said "maintaining the high standard of patient care that we currently provide" was paramount in the process of achieving equitable staffing levels through talks with staff, health councils and communities.

He said the proposed reduction of nurse hours in places such as Nyngan would see money eventually redirected to community-based care to reduce hospitalisation rates in the health district that are 30 per cent higher than the "rest of NSW".

In the future the health district would call for expressions of interest from nurses keen to develop skills needed for working in the community, the chief executive said.

Mr McLachlan refers to countries such as Scandinavia, Canada and New Zealand, where well-organised and co-ordinated community medicine is easing the strain of ill health on people and hospitals, when talking of the health district's future direction.

"Everyone agrees that this is a good idea," he said.

"Going through the changes is always difficult and we don't underestimate the impact that has on human lives in country towns."

Mr McLachlan said given the "incredible" difficulty of recruiting nurses for small rural communities, the health district would "still have a lot of work for casual and temporary staff".

Representatives of the health district and the union are scheduled to meet today in Orange.