Health workers' unions have lodged a formal dispute with the Norfolk and Norwich University Hospital over its plans to scrap nationally agreed terms and conditions for new staff.

The hospital is proposing to change its terms and conditions for new staff, offering them a worse deal, as part of its plan to find �30m of savings by the end of next March.

It says that while other efficiencies are being made, the only way it can achieve savings of �80m over the next three years is to find ways to reduce its wage bill, which represents 57pc of its outgoings.

But the plan to downgrade from the national benchmark, known as Agenda for Change, has angered staf,f and now unions have clubbed together to register a dispute ahead of the proposed change from January 1, 2011.

The unions involved include Unison, Unite, the Royal College of Nursing (RCN), the Royal College of Midwives (RCM), the Society of Radiographers (SoR), the British Dental Association (BDA), the Chartered Society of Physiotherapy (CSP), the British Association of Occupational Therapists (BAOT) and Managers in Partnership (MIP).

Adrian Ing, the RCN's regional officer for Norfolk and Suffolk, described the plans as 'a dangerous step' and said the new terms would also apply to existing staff who are promoted, change hours or change roles.

He said it could affect the hospital's ability to attract the best staff.

Mr Ing said: 'I would hope there wouldn't be a dramatic impact on patients, but when you are dealing with a workforce which has been browbeaten into lesser terms and conditions it must have an impact on staff morale.'

Anna Dugdale, chief executive of the N&N, said the hospital was looking at ways of reducing the wage bill, and all of the options were unpleasant and unpopular, but it was trying to find the least damaging of all the alternatives.

She said: 'We are in the very early stages of negotations. It is a negotiation. It is a discussion and we are exploring all sorts of possibilities in order to reduce our overall pay bill, which is something we recognise we have to do over the next five years.'

One N&N nurse, who wished to remain anonymous, said: 'Nurses have fought for years to get decent pay. You do your job because you care and it's not all about money but we fought for decent pay and now they are trying to take it away from us.'

The RCN has had contact with thousands of nurses through its Frontline First campaign website and has identified that 3,804 NHS jobs have been earmarked to be axed in the East of England. However, it says that the N&N's proposals to chance the terms and conditions is one of the biggest issues the region is facing, as it could lead the way for other trusts to do the same.

The RCN's Frontline First report has identified five typical approaches in the NHS to slashing workforce costs, and which are likely to be seen at trusts across the country.

They are:

n Removing or freezing posts. The majority of NHS trusts are placing temporary freezes on vacancies or deleting clinical posts. A typical scenario is that posts are not filled when they become vacant through sickness or maternity leave, service redesign or redundancy.

n Delaying recruitment. Some trusts are extending the time taken to recruit against vacant posts.

n Diluting skill mix. By replacing regulated staff with unregulated workers, trusts are diluting the balance of skills in care teams to save money.

n Down-banding posts. The NHS operates a nationally agreed pay system that allocates the pay of staff (except doctors and managers) according to various pay bands. Some trusts are redesigning job descriptions so they can pay staff on a lower pay band.

n Encouraging staff to leave. Some trusts are asking staff to come forward for voluntary redundancies or early retirement.

The Frontline First campaign site and full report can be found at www.rcn.org.uk/frontlinefirst