Frontline NHS staff could be given a guarantee that they will be able to keep their job if they are prepared to be paid less, health secretary Andy Burnham announced today.

They may also need to work in a different NHS organisation or a different place.

Outlining a five-year “vision” for the NHS, Mr Burnham said the Department of Health was going to work with trade unions to explore the possibility of guaranteeing nurses’ jobs in return for lower pay.

The document, From Good to Great: preventative, people-centred, productive, emphasised that over the next few years more care will need to be provided in community settings and less treatment should be provided in hospitals.

Mr Burnham said staff may need to change jobs to reflect this change, but said he did not want the recession to mean mass redundancies of frontline NHS staff.

Speaking at the launch of the strategy, Mr Burnham said: “In my view if you are going to have an NHS that’s providing care in the community and the home that does not necessarily mean you need fewer staff.

“I’m very clear that we were in a situation a few years ago in the NHS where people had financial pressure and lots of redundancies were announced… I do not think we need to get into that position.”

The document said the DH would work with NHS Employers and trade unions to “explore the pros and cons of offering frontline staff an employment guarantee locally or regionally in return for flexibility, mobility and sustained pay restraint”.

“This may require tough choices for staff, including working in a different place or in a different organisation.

“It will also require a joint commitment to ensure tight control of the total pay bill.”

Yesterday chancellor Alistair Darling announced that nurses’ pay rises would be no more than 1 per cent for two years from 2011.