The Royal College of Nursing may pull out from negotiations with ministers over a new pay structure and careers system for nurses.

A Department of Health spokesman said: "We expect significant progress between now and the next council meeting of the RCN on July 27. We hope to begin implementation before the end of the year."

Forum Response: Royal College of Nursing

Dr Beverly Malone, general secretary of the Royal College of Nursing, told ePolitix.com: "The government opened discussions on Agenda for Change three years ago. The process has been repeatedly delayed which is a cause of unrest and disillusion amongst nurses.

"Despite the Budget announcement two months ago of increased spending on the NHS, we are still awaiting the government's proposals on the new NHS pay and careers system. If the government does not make a satisfactory offer for nurses soon, we are unlikely to have final proposals to submit to our review body in September. This position is no longer tenable."

Forum Response: Unison

Paul Marks, national secretary for UNISON, told ePolitix.com: "We share the RCN's frustration at the pace of these talks, but this is a complicated process and the results will have far reaching consequences.

"The review has to be done well and done right. We've got to get it right for the sake of the whole health team.

"The government has to understand we won't let the process drag on indefinitely and that the key to its successful implementation will be adequate funding."