The recession is coming for Agenda for Change.

The landmark agreement five years ago standardised pay and conditions for nurses and other non-medical staff, securing equal pay for equal work and providing consistency between providers.

But now senior managers are beginning to argue that the impending spending cuts require more flexibility. In particular, they feel there is a poor trade-off between commitments to staff to creep up the pay scale and delivery of productivity improvements.

And talk of pay freezes is gathering momentum. Unions are faced with growing evidence that contracting funding means almost any pay rise will be funded by job cuts - which in turn means falling union membership.

Jobs are already being cut in the NHS. As the painful reality of finding £15bn-£20bn of economies becomes clear, employers are going to need changes made to deals signed in a time of plenty.

Trusts must of course be sensitive to the impact one-size-fits-all pay freezes could have on low paid workers, of whom there are still many in the NHS. But tough negotiating on freezes, job flexibility and productivity will be part of the new landscape.

NHS pay freezes move up management agenda