Managers at Oxford's major hospitals fear a new national pay structure could entice nurses and other NHS staff away from the city to work in London.
The system will entitle workers in the capital to 20 per cent extra on top of their basic salaries -- giving them £3,000 to £5,000 more than nurses in other areas.
Hospital staff in Greater London will be given a 15 per cent top-up, and the London fringe will get five per cent.
Nurses in the capital already get a £3,228 annual bonus, but Oxfordshire nurses have been persuaded to stay in the county because they get a weighted salary through the Department of Health's high cost area scheme.
But Oxfordshire will not be included in the new weighting system, and it is feared staff will leave the region to earn more money elsewhere.
The Oxford Radcliffe Hospitals NHS Trust, responsible for Oxford's John Radcliffe Hospital, Churchill, and Radcliffe Infirmary, and The Horton, Banbury, has historically struggled to recruit and retain nursing staff because of the area's high cost of living.
It has recently made headway in employing more staff, but there are still about 200 empty posts and the new pay structure could tempt more nurses to leave.
Helen Munro, human resources director at the Oxford Radcliffe Hospitals NHS Trust, said many would be tempted to buy an annual £900 bus ticket to work in London, where they could earn £5,000 extra.
She said: "It's a worrying situation. Anyone who has just moved to Oxford and is trying to find a home, soon realises it's expensive and they can't afford it.
"If they had the opportunity to move to a hospital in London for extra money, then it's very do-able.
"I am concerned about it. We've successfully recruited more nurses recently but we do have difficulties here.
"People are already living in Oxford and working in London. We know staff who do weekend shifts there because of the premium money they can earn -- but I don't want the flood gates to open.
"I want people to understand how expensive it is to live in Oxford, so we are writing to the Department of Health, and I think they will be very sympathetic to people like ourselves."
The new pay structure, which will be implemented in October 2004, will not only effect nurses, but other NHS staff like radiographers, who take X-rays and carry out radiotherapy.
The system will mirror recruitment problems at Thames Valley Police, where officers leave to work for the Metropolitan Police, where they earn £7,000 extra.
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