Doctors can hardly conceal their glee, the unions are furious, and managers have been warned that their pay rises

should be 'disciplined'. Mark Crail reports on this year's pay round

Trade union leaders arriving at Richmond House to hear what the government planned to do about this year's pay review body reports were on familiar ground. Most had had many similar meetings with ministers to hear very similar decisions.

But for those on the other side of the table, it was all new. Flanked by health minister Alan Milburn and political aides Simon Stephens and Joe McCrea, health secretary Frank Dobson admitted that he had some good news, and some bad news, to impart.

'I've never done this before,' he told them, before admitting that - just as Conservative ministers did last year and in defiance of the review bodies' recommendations - he intended to stage the awards.

John Chisholm, chair of the British Medical Association's general medical services committee, told the Journal: 'It was a very similar message to previous years, but ministers obviously have different personalities. Frank Dobson is a very genial man.'

The news he had to impart, however, was greeted with predictable disappointment among the unions, with the staff side of the professions allied to medicine claiming that it represented the fourth pay cut in a row for their members.

The settlement means all groups covered by the review bodies will get 2 per cent from April, with a further rise from 1 December, giving a third of a million nurses and more than 40,000 PAMs a full-year increase worth 3.8 per cent.

But the second-stage increase will mean a total increase of 4.2 per cent on the pay of 40,000 hospital doctors - and a substantial 5.2 per cent to the net income of nearly 30,000 GPs. Emerging from the briefing, doctors' leaders could barely conceal their glee.

By the time the recommendations are implemented in full, GPs working full time can expect to earn pounds51,970 basic pay, plus a further pounds3,500 as a result of hitting health targets. A further pounds60m will be distributed later by agreement with the profession.

Unusually, both the doctors' and nurses' review bodies feel the need to use their reports to assert their independence, and to restate their view that their prime objective was to be fair both to the taxpayer and to the staff groups within their remit.

All review body chairs were called in by chancellor Gordon Brown at the end of last year to be lectured on financial probity. But for the doctors' review body in particular, this has been a difficult year in which it faced growing discontent among doctors.

Delegates to the local medical committees' conference last year came within a hair's breadth of demanding the resignation of all its members, while review body chair and Yorkshire Water chief Brandon Gough came in for especially heated criticism.

Both review bodies also slapped the NHS Confederation on the wrists for claiming in its evidence that while it wanted to see a pay award 'which is both reasonable and affordable... these two objectives cannot both be achieved in 1998-99'.

As the nurses' pay review body commented: 'We considered it regrettable that the NHS Confederation felt constrained to seek an award which would, in its own view, be affordable but not reasonable.'

But there were few criticisms of either review body, and most staff-side bodies concentrated on the detail rather than the overall level of their recommendations, while the NHS Confederation raised concerns about affordability in 1999-2000.

Confederation chief executive Stephen Thornton said: 'Given these awards, the first 1 per cent of any new money the NHS gets in 1999-2000 will have to go on funding their full-year impact.'

But he was satisfied that the 2.7 per cent effect on the next year's pay bill could be met from the money already allocated to the NHS. He said the confederation would be 'looking for a commitment from the government' to meet the full-year bill.

Meanwhile, local union and trust negotiators will be looking to the small print. Local pay may, at least for the time being, be dead, but some of its manifestations live on.

With a generosity that will be lost on many trusts, the nurses' pay review body suggested that 'where trusts wish to settle at above our recommended salary scales for 1998-99, they should continue to have the discretion to do so'.

It said that, although unable to recommend national increases in lead payments and allowances, trusts should 'bear in mind' the impact that not increasing them had on morale, and went on: 'We urge trusts to increase relevant leads and allowances.'

It also proposed a series of discretionary pay points for senior clinical nurses and PAMs which could add up to pounds1,200 to the pay of clinicians at the top of existing pay scales. Details of that will be thrashed out later by national negotiating bodies.

And, with a warning shot across the bows of local pay enthusiasts, it added its 'view that our recommendations should apply to nursing staff on shadow Whitley contracts in the same way as they apply to staff on Whitley contracts'.

The final word, however, must surely go to 'genial' Frank Dobson, who could not resist preaching his message of being 'as fair as we can to all staff'.

Or, as he went on: 'That means applying the same overall discipline on pay to all staff in the NHS - including managers. And I shall be making it clear to the chairmen of trusts and health authorities that I expect them to make it stick.'

Review Body on Doctors' and Dentists' Remuneration: 27th report, 1998. The Stationery Office. pounds14. Review Body for Nursing Staff Midwives, Health Visitors and Professions Allied to Medicine: 5th report on nursing staff, midwives and health visitors, 1998. The Stationery Office. pounds9.