Yes, please, says the BMA - about 14 per cent would do nicely. As the annual pay review tussle hots up, Laura Donnelly and Tash Shifrin find out who wants what, and how badly

The nights are drawing in. Hopes of an Indian summer have faded away. It's autumn - and that means it must be time for the annual pay wrangles to notch up a gear.

This week the NHS pay review bodies received their final submissions from the British Medical Association, health unions and the NHS Confederation, among others.

The Department of Health also handed over its evidence, along with offerings from the Scottish Executive and the Welsh Assembly.

All the key players are in place - but while the unions argue that substantial pay rises are the key to addressing the NHS's staffing crisis, the employers stress the importance of dealing with workload pressures to tackle retention problems.

And the submission from the DoH gives a clear indication that it wants to see pay increases of no more than 2. 5 per cent.

It calls for a rise that 'takes full note' of the settlement with non-review body staff - which set a figure of inflation plus 0. 5 per cent.

The health departments' evidence warns that big increases could undermine the NHS's ability to deliver the NHS plan, and lead to high unemployment.

The health departments' submission urges the review body not to recommend 'structural change, including the consolidation of discretionary points, in advance of pay modernisation'.

But old habits die hard at the BMA, which is demanding a pay rise of 'at least 14 per cent'.

'Grossly exorbitant!' thunders the confederation. Certainly a little tactless in a year in which the profession has been tarred with the brush of Harold Shipman, and ongoing battles over revalidation.

So how do the doctors justify their fiscal needs? In a well-rehearsed argument, the BMA suggests that higher pay would recognise an overall shortage of doctors and the increasing 'clinical and administrative demands' they face.

It suggests that 6 per cent is needed to maintain the profession's relative position, with a further 8 per cent to make up for slippage since 1996.

The BMA paints 'a desperate picture' of the workload for those working in specialties with a shortage of consultants, excessive hours worked by junior doctors and problems of poor morale.

It also highlights the 'considerable, disruptive change'over the past 12 months with the development of primary care groups.

The staff-side submission from nursing, midwifery and health visiting staff also flags up an increasing workload.

They are seeking a 'substantial' rise all round - with measures to eliminate the lowest three pay points for non-registered nursing staff, 'significant numbers' of whom qualify for state benefits, and to consolidate the discredited discretionary points scheme for senior staff into F to I-grade pay scales.

The staff-side submission also calls for consultant nurse pay scales to begin at a level higher than the current I-grade. 'A Eurostar train driver gets more than a consultant nurse, ' staff-side chair Maggie Dunn points out.

The Community Practitioners' and Health Visitors' Association's Jane Davies says low-paid, non-registered staff have shown her newspaper advertisements for shelf-stacking jobs at£7 an hour, 'which was quite a substantial increase on their salary', she says. 'Some of them are going. '

'Nothing is going to be a substitute for nurses having an appropriate, decent salary and an appropriate, decent career path, 'says Ms Dunn. It is a view which has little common ground with that of the confederation, or of the health departments. All repeatedly stress the factors other than pay which impact on recruitment and retention.

Confederation human resources director Andrew Foster insists that a higher overall pay increase 'is not the solution' to current recruitment difficulties, which are in general caused by factors other than pay.

The confederation is calling for a pay award set at the underlying inflation rate plus 0. 5 per cent for all review body staff, in line with the award already negotiated for non-pay review body staff.

Its submission points out that an NHS Executive survey in 1998 did not identify better pay as a key factor that would make nurses no longer working in the profession consider returning.

And evidence from the health departments flag up the comprehensive range of HR initiatives currently being developed, including extra investment in things like childcare.

But the unions caution that many HR initiatives have yet to make a noticeable impact. They agree with employers that 'addressing current staff shortages would ease problems of recruitment and retention and create a 'virtuous circle'''.

But these problems 'will not be solved. . . in the absence of improvements to pay'.

For the unions, the circle is rather more vicious: staff side agrees that retention rates would improve if staff shortages eased. But it doesn't believe that new staff will join without improvements in pay to attract them.

And Ms Dunn stresses that the inflation plus 0. 5 per cent figure for non-review body staff is 'a floor, not a ceiling'. The way the unions see it, the only way is up.