A shortage of nurses and casualty doctors has been diagnosed

Professor James Kennedy, of the Royal College of Nursing, claimed Scotland had one of the slowest growing workforces in the United Kingdom.

And the British Medical Association has alleged 62% of accident and emergency units had lost a staff grade doctor to general practice in the last year.

BMA spokesman Mohib Khan said something had to be done to stop the problem.

Staff grade and associate specialist (SAS) doctors comprise about half of the doctors in casualty departments, excluding trainees.

These doctors often receive little or no extra pay for working antisocial hours.

The BMA's research, compiled from a survey of 138 hospitals, found that seven in 10 A&E departments had vacancies for staff grade doctors.

Three quarters of people interviewed complained about the inequality of pay between casualty department doctors and other medical staff, such as out-of-hours GPs.

Although the NHS Employers' Organisation is preparing to negotiate with the BMA on new contracts, no deal can be clinched until the go-ahead is given from government health officials.

We're running at half the growth rate of the rest of the United Kingdom at a time when the workload is increasing and increasing Professor James Kennedy Royal College of Nursing

Mr Khan, chairman of the BMA's staff and associate committee, said: "Unless things get better for this group of doctors, there are going to be serious problems staffing hospital emergency departments.

"The BMA has always had concerns that poor conditions for staff grade and associate specialist doctors would be bad news for patients.

"This is evidence that their neglect poses a real threat to accident and emergency services."

Health Minister Andy Kerr said: "It isn't just about money. It's also about what career path do these particular doctors have within the service and we want to address that.

"The money is there. We need to make sure our priorities are right and we need to work with the professionals and the staff involved in the health service to make sure it all goes well for Scotland."

He added: "We want to make sure we provide attractive terms and conditions and also, I think more importantly, career development and professional opportunity."

At the same time, nurses' leaders have attacked ministers over what they argue is a staff shortage on the wards.

Prof Kennedy, of the RCN, said: "Staff have seen real growth of the nursing workforce south of the border.

Andy Kerr said money was "not the issue for the health service"

"They feel there are more nurses at the front line. In Scotland, despite an increasing workload, that has changed very marginally."

He added: "The Scottish Executive's targets are purely in relation to recruitment. They're not in relation to retention or growth.

"We're running at half the growth rate of the rest of the UK at a time when the workload is increasing and increasing."

Prof Kennedy said: "We have to get to the position where the four health departments across the UK agree to do some research of the cross-border flow of nurses so that we understand why nurses are moving around the UK.

"The solutions are there but the major issue is workload. At the present time the future is fragile."

Offer of talks

Mr Kerr defended the executive's position saying: "I would question some of the numbers, but I don't think that's the debate today.

"As I look at the vacancy numbers, they are described to me as normal in terms of the vacancies we have in the service.

He added: "It's largely academic. If there's a feeling out there from nurses that we are not dealing with the issue properly, then I am happy to discuss with them and take that forward.

"Some work has been done on that and that work will continue."

The minister said: "Money is not the issue in the health service. I think it's about how we use our resources effectively.