NHS Fife currently has four unfilled posts in emergency medicine due to long term sickness, maternity leave and problems recruiting doctors, forcing the board to come up with a contingency plan.

If staffing solutions fail, health bosses believe it might not be possible to provide medical cover at Victoria Hospital between midnight and 8 a.m.

The latest position was highlighted at a meeting of NHS Fife's operational divisional committee last week.

A spokesman for NHS Fife said: "Should this become necessary A & E services would be concentrated at Queen Margaret Hospital, with a minor injuries service continuing at Victoria Hospital.

"This is because surgical services are centralised at Queen Margaret Hospital (QMH). Work on this contingency plan is ongoing and involves our patients' forum.

"If this were to happen, based on present attendance patterns, we expect at most four to six patients on any weekday night to have to travel to QMH for further assessment and treatment.

"The majority of people who attend the Victoria A & E during the night can be seen by an emergency nurse practitioner, who has support from the medical staff in the hospital."

In the past, NHS Fife has been able to fill short term vacancies by locum appointments and the board has made considerable efforts to maintain a pool of potential locums.

However, this solution has become more difficult, however, due to new schemes and rules governing recruitment of doctors from overseas, both of which have reduced the pool from which such doctors are drawn.

As an alternative, NHS Fife is developing both the pool of locums and a group of Fife-based GPs with training in A & E medicine.

In the long term, Fife is set to have only one A & E department.

A & E services will be based at the Victoria Hospital, with a minor injuries service at Queen Margaret Hospital when the new build at Victoria Hospital is completed and commissioned in early 2012.

The NHS spokesman added: "As the population of Fife rightly expects, our primary focus is on the provision of safe accessible services."