Nurses are being urged to sign away their unions' national bargaining rights as the price of a 3 per cent pay increase.
An increasing number of NHS trusts are insisting employees agree individual contracts before awarding a 2 per cent local rise on top of the 1 per cent national award, the Royal College of Nursing has found.
Managers are taking advantage of a recent House of Lords ruling which allows employers to discriminate against trade unionists who insist on collective bargaining by paying them less.
The Ipswich Hospital Trust and the James Paget Trust, at Great Yarmouth, have told nurses that only those who sign a local contract will receive a 3 per cent rise, the rest will only get the 1 per cent national increase.
The RCN believes that while many of the "first wave" of trusts who have struck agreements with staff have conceded 2 per cent additions to the national offer, many of the hundreds of NHS employers still to complete deals may insist on local contracts and stringent productivity deals.
There were some signs yesterday that NHS officials may be trying to rein back on local contracts. Ken Jarrold, NHS personnel director, said in an interview with the Nursing Standard in February, before the review body made its recommendation, that "in no circumstances" should nurses be forced to sign local contracts in order to win a pay rise.
In an interview on Radio 4's World at One however, he defended the move towards local negotiations. It would enable employers "to respond flexibly and promptly to change in patient care and to employment patterns". He said they should receive a reward which was appropriate "to the work that they do and the local labour market in which they work". He added, however, that trust-based discussions were happening in a "national framework".
The news emerged yesterday as thousands of health workers staged a nationwide "out to lunch" protest involving marches, rallies and leafleting campaigns. The RCN and Unison, the public services union, estimated that there were about 415 events around the country in support of a 3 per cent increase for all NHS employees.
Bob Abberley, Unison head of health, said it had been the biggest demonstration of anger among health service employees since 1982. "The Government must listen to the united voices of 900,000 health staff who are demanding a fair pay deal. And they should listen to the public who have given us unprecedented support."
He described the 1 per cent offer as "an insult". He said John Major should intervene and the Government should make an award at the national level to ensure a fair deal for all NHS staff.
In the Commons the Prime Minister characterised the Government's treatment of health workers pay as "scrupulously fair".
Mr Major pointed out that the recommendations of the nurses' pay review body had been accepted "in full". He said the Government had provided extra money to the NHS to meet the pay rises.
Tony Blair, the Labour leader, said the increase was "yet another damaging blow to the morale of the NHS".
The health executive of Unison is due to meet next week and it is understood it is likely to recommend industrial action. The union is to undertake a period of consultation ahead of a possible ballot on disruption.