A health authority was accused last week of demoralising staff and potentially fragmenting services by joining with GPs to put community nursing out to tender.
Dudley HA proposes that health visitors, district nurses and specialist community nurses are based in GP practices. That could mean a change of employer for the 150 community nurses now employed by the Dudley Priority Health trust.
Health visitor Bronya Webster said the move would adversely affect services for children and elderly people.
'At no point has anyone criticised the delivery of services by staff on the ground. They think the nurses and health visitors deliver a very good service, ' she claimed.
Ms Webster, who is also a local representative of the Community Practitioners and Health Visitors Association, said that if the tender went ahead children would be subject to two different sets of child protection regulations, and developed health prevention routines for older people would be replaced by a crisis intervention service.
CPHVA labour relations director Roger Kline said he believed it was the first time all of an HA's community nursing had been put out to tender.
He said: 'I believe the HA is doing this in defiance of advice from region and the Department of Health.'
Dudley HA chief executive Henry Foster said the decision had been taken unanimously by the 10 members of the HA, which was working with five GP commissioning groups in Dudley.
Seven bidders, all of them trusts and including Dudley Priority, had been short listed for the contract. The expectation was that staff now employed there would be transferred to the successful provider.
Mr Foster denied that Dudley was unique in its approach, but using arrangements introduced by the previous government.
'We have explained our decision both to regional office and through them to the DoH and the result is that we are proceeding with the approach.'
The DoH said it was a local matter to be settled in the usual way. But it is rumoured that Dudley's decision to tender has embarrassed ministers.
Local MPs are understood to be considering raising the matter in the Commons.
Mr Kline said his union has been 'in almost continuous meetings' between the HA and the trust to persuade them to drop the scheme.
A West Midlands NHS Executive spokesperson said: 'Regional office regrets the fact that this situation has developed and is now seeking to ensure there is minimum disruption to the delivery of community nursing services.'