Employers and unions were set for a head-on collision over pay as the last submissions to the NHS pay review bodies were handed in this week.

The NHS Confederation's written evidence to both the doctors' and nurses' bodies calls for a pay award at the underlying rate of inflation plus 0. 5 per cent, in line with the award already negotiated for non-pay review body staff.

But the British Medical Association is demanding a pay rise of 14 per cent for all doctors. And the staffs negotiating council for nurses and midwives is expected to call for a 'substantial'pay rise, with particular account taken of the pay levels of non-registered nursing staff.

A draft of its written evidence, seen by HSJ, also says discretionary points for senior nurses should become increments added on to the top of pay scales F to I.

The Department of Health this week played up a recommendation in its evidence for discretionary points to be used to reward nurses who 'take over new responsibilities given to them under the NHS plan', saying nurses who receive a maximum of three points could earn an additional£1,200.

The government also wants to ensure that fast-track access to bonuses is given to consultants who work exclusively for the NHS (see story, right). But overall the DoH's evidence says it is looking for an increase that 'takes full note' of the settlement with non-pay review body staff.

The confederation described the BMA demand as 'grossly exorbitant'. It said a large part of the extra funding found for the health service must be reserved for modernisation. Human resources policy manager Alastair Henderson said a balance had to be struck between the cost of bringing in new staff and rewarding existing staff since the NHS plan could not be implemented without extra recruits. When it came to retention, he said 'workload, the pressure they [staff ] are under and the way they are valued' was more important than pay.

In stark contrast, the draft submission of the staff negotiating council for nurses and midwives argues that increasing pay is key to tackling recruitment and retention.

The Community Practitioners' and Health Visitors' Association said pay settlements in the economy generally were running at between 1 and 2 per cent above inflation, so it would 'strongly oppose' any pay award at non-pay review body levels.

The BMA said doctors needed extra money to catch up with 'comparable' professions, including 8 per cent to make up 'slippage' since 1995.

It's not about the money: the Confed's evidence The NHS Confederation's written evidence was based on consultation with all NHS trusts, health authorities and health boards. The arguments and key messages in the pay review body submission were supported by 99 per cent of the 209 responses received by the cut-off date. Some comments from NHS organisations:

One pay award for all staff would reinforce the message of one NHS and help break down barriers between professions.

The issues for most staff are now around workload. The majority would prefer to see more staff rather than higher pay.

Pay awards must be fully funded, including the additional superannuation costs.