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In the brave new world of multidisciplinary and multi-agency teams, how much you earn may depend not on what you do but on who your employer is, which may lead to disparities in pay and conditions. Sarah Wellard reports.

How would you feel if, several months into a new job, you discovered most of your colleagues were earning several thousand pounds a year more than you, even though they had similar qualifications and less post-qualifying experience? Or what if the boot was on the other foot and you were earning several grand more than better qualified colleagues doing exactly the same job? Beware. As the new care trusts come on stream over the next few months, this is exactly the position that many of their new employees may find themselves in.

Keith Bramber (not his real name), a psychotherapist working in a community mental health team for a health trust in the south east, knows how unpleasant this experience can be. A few months after starting work in 1999 he discovered that most of his co-workers were earning around £3,000 a year more than him. He says: "Knowing you are undervalued is hard to live with. We're doing exactly the same job, with the same job title and job description."

Most of Bramber's co-workers are community psychiatric nurses (CPNs), but there are also social workers, a psychologist and an art therapist. He says: "It makes some people feel guilty and feel that they should work harder. Other people are resentful and feel they should work less hard. It's very difficult to raise it with managers without being seen as difficult and negative."

After two years of negotiation, Bramber eventually succeeded in getting his and a colleague's pay upgraded in line with the nurses. But no back pay was offered. And now that the government has introduced special cost of living allowances for key workers, a differential has appeared again, of £600 a year. This time social workers as well as psychotherapists and art therapists are losing out.

Some might argue that staff from professions like social work and psychotherapy, which are not aligned to medicine, are always going to be at a disadvantage working in the NHS, where the medical model predominates and there is a tendency to undervalue social or psychoanalytical perspectives.

Nurses and teachers employed by social services may also lose out financially, according Dawn Gregory, who manages five multidisciplinary community child mental health teams in Norfolk. When Gregory began setting up the service three years ago, the department agreed that all staff should be employed on the same job description and the same pay scale, irrespective of their previous professional identities. She says: "Because of the way the government has targeted some professions with extra pay increases, health staff and teachers in the teams now earn less than if they had stayed within their own service. The government wants us all to be fully joined up, but they haven't thought through the practicalities in terms of pay and conditions. A health visitor or school nurse could be earning about £2,000 a year more." Which is a considerable amount of money, especially as none of these jobs are particularly well paid.

Gregory would like to be able to improve everybody's pay, but that isn't an option. Instead, she talks about finding ways of managing the difficulties that can arise. She says: "People coming into these teams are usually up for a challenge. But sometimes when you really want a job you don't always think through the downsides, like realising that in three years time you won't be earning as much as if you'd stayed within your profession. You can't shove it under the carpet. You have to talk to staff about it without becoming defensive."

Rob Pinkham, deputy director of the Employers' Organisation for Local Government, anticipates that these kinds of difficulties may increase as more staff find themselves working in teams alongside staff from other employers. He says: "Bringing together staff from difficult cultures, with different training and different approaches to customers is a big challenge. We're not yet picking up on many difficulties, but it's still very early on in this process. Our view is that organisations should aim to develop a common pay structure before transferring staff, but the speed at which changes occur means that doesn't always happen."

Staff transferring to care trusts will be covered by the Transfer of Undertakings (Protection of Employment) Regulations 1981 (Tupe) employment protection rights, ensuring that pay, terms and conditions are not worsened. But at some stage trusts have to introduce a new pay structure and try to persuade people to transfer. Pay and conditions for health service workers are under review and the first tranche of care trusts have yet to devise new structures.

Owen Davies, social services national officer at Unison agrees that experiences like Bamber's are likely to become more common if employers introduce different pay and conditions for new staff. He says: "Most of these organisations respect Tupe. It's rare for us to have members complaining that they been pressurised to accept poorer conditions. So you have the transferred workforce on Tupe and the new staff on lower conditions. It becomes a two-tier workforce that leads to bad industrial relations."

Davies does not think that a single unified pay structure for all staff in health and social care would be a panacea. Instead, he believes that proper funding for new bodies is the best way of preventing organisations that generally accept that they have a social purpose from behaving like bad employers.

In practice, however, managers of teams of staff seconded from several different employers rarely have any control over pay and conditions. Workers may be doing a similar job for hugely different rewards. This is the experience of many youth offending teams (YOTs) who typically include a mixture of directly employed and seconded staff. Mike Hitchings, acting manager of Wiltshire YOT, explains that at first the team adopted a generic approach, with social workers, police, probation officers, the CPN and educational welfare officer all doing more or less the same job.

"When we set up it was a problem. Now three years on it doesn't feel like one anymore," says Hitchings. "Initially we went for a generic approach which heightened the sense of unfairness as well as professional tensions with people feeling, 'I've been trained to do this. How can you come in and do it without training ?' Now team members have reverted to more functional roles, with staff working more closely in line with their professional experience."

Hitchings adds: "Before the YOT was set up, we were all working with the same young people but with little knowledge or understanding of what staff from other agencies were trying to do. Now we're doing it as a team."

Janette Brown, programme manager for Howdon Sure Start in North Tyneside, agrees that differentiated roles within a multidisciplinary team, with each member understanding the role the others play, can help a team work together without tensions arising about differences in pay and conditions. She has day-to-day operational responsibility for 47 staff, all of whom are seconded onto the programme by their employers, who include the local authority, a health trust, a voluntary organisation and private sector not-for-profit business. "So far pay and conditions haven't been an issue,"she says. "It's not something I've discussed much with other Sure Start managers, but the varying hours worked by staff contracted to different organisations could be an issue for the future."