You could tell that Tony Blair's promise to create a class of 'supernurse' consultants had made some sort of impact on the public mind, even in a week of high Clintonian drama.

As a patient whose kidney stone is finally being zapped at great expense by the NHS, I won't hear a word against nurses this week, super or otherwise. I am even moderately well disposed towards doctors, though I feel sure that won't last the negotiation of the British Medical Association's annual pay claim - 10 per cent this year.

The general reaction to the prime minister's move, made at the Nurse of the Year awards (very New Labour), was one of surprise, as HSJ has reported. The initiative seemed a little clumsy at this stage in the nurses' pay round, albeit consistent with the trend towards rising clinical responsibility for nursing staff. 'Long overdue,' observed the Royal College of Nursing's Christine Hancock.

It did not surprise me, because I have heard Mr Blair talk, unprompted and in private, about giving good nurses - and teachers - financial incentives to stay at the sharp end of the trade, rather than move into management or simply leave. It's a cyclical reaction - that's cyclical, not cynical, Mr Editor - by which I mean it keeps coming back.

'They first tried incentive payments for teachers in Victorian times', explained a friend of mine. New Labour has many virtues, but reading history books ('they're so uncool') is not one of them. Health minister Alan Milburn would say he wants to remove what one calls 'the glass ceiling at the top of the tree for nurses' who also get to a certain level (ditto teachers) in the 26,000-a-year range.

Unlike 21-year-old management consultants, who start on that sort of money, they must leave the classroom to get any further.

Fair enough. But even before the TUC delegates arrived in Blackpool, the familiar dilemma of pay structures was clear: how do you address falling recruitment if the starting rate of around 12,500 remains so low, and how do you ease the drop-out rate of, is it, 15 per cent?

Dobbo's August promise of a single-stage payout won't do wonders if it is Gordon Brown's hair-shirted 2 to 3 per cent, which simply keeps pay abreast of inflation. Frank and Gordon are arm-wrestling on the figure.

Indeed, the Mail unkindly asked Paula Taylor, the Nurse of the Year herself, what she felt. Despite receiving a 3,000 cheque from Mr Blair's own hand (her award, not her pay increase), she said it would make most nurses - the un-super ones - feel 'impoverished and disillusioned'. Unison made the same point, that 'the core problem is low pay across the board and chronic staff shortages'.

With all that 'extra' money slopping around the NHS (extra? Let's hoist Downing Street by its own media petard), ministers know that pressures will mount. Unison's Rodney Bickerstaffe, one of the TUC delegation which got polite-but-short-shrift from Blair at Number 10 the other day, constantly stresses his campaign for decent wages in the public sector to ease poverty.

He will come under growing internal pressure if he fails. As one well- placed Labour minister remarks, 'there are still a lot of mad Trots in Unison'.

At which point militant noises from the BMA don't help. In that respect I can offer a crumb of comfort. Weekend reports of huge 'loyalty bonuses' for consultants who agree to work full-time for the NHS came as a surprise to health ministers as well as the rest of us. You may recall that the BMA's opening gambit on consultants' pay this year was to suggest lifting the 10 per cent cap on non-NHS earnings.

It has been quietly eroding in recent years according to official surveys - honoured in the breach. Ministers want to retain consultant loyalty, but aren't yet talking bonuses. As I write, Unison delegates on the windswept Blackpool seafront are hinting at NHS industrial action. Education secretary David Blunkett is talking of balance and the need to avoid staging. He might have added, avoid recession. That would do wonders for recruitment.