HSJ’s disclosure of NHS Employers’ move to extend the pay freeze coincided with a warning from the acute sector that existing pay agreements were unsustainable.

A Foundation Trust Network survey of 76 members - to be presented as evidence to the Doctors’ and Dentists’ Review Body - found a unanimous view that the scale of trusts’ financial challenge meant changes to pay, terms and conditions were required.

More than two thirds of the FT leaders responding (68 per cent) did not believe the current framework was sufficiently flexible, while 42 per cent supported local discretion in the implementation of a pay award. FTN members also backed linking pay increases more closely with productivity gains.

The FTN said it would seek an extension to the pay freeze.

FTN chief executive Chris Hopson said members were “frustrated by the rigidity of the pay system”.

“We need to look again at embedded annual pay increases created by incremental awards that have almost come to be seen as automatic rather than something to be earned,” he said.

“To award an increase when trusts are already struggling because of financial pressures would be damaging. We hope that staff will understand that this restraint enables us to protect more jobs and invest in patient care.”

NHS Employers’ action was criticised by unions.

Unison head of health Christina McAnea said: “This is merely petty scaremongering on behalf of employers, when we know for a fact the settlement they will receive for the NHS will be enough to cover a 1 per cent pay increase for staff.

“It’s time for employers, and the body that represents them, to get real. Staff are really struggling; their pay has been frozen for two years while their pension contributions have increased and the cost of living has soared. At the same time they have been coping with a massive reorganisation of the health service.”

Unite head of health Rachael Maskell said: “NHS bosses are wildly out of touch with their own staff. Managers have already instituted massive cuts to staffing levels which are currently adversely impacting on patient care. NHS staff are at breaking point.

“NHS Employers appear to be trying to launch a pre-emptive attack on the independent pay body review process.”

EXCLUSIVE: NHS Employers backs pay freeze