Ambulance technicians fear a pay cut as well as lost bonuses
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Ambulance technicians in Merseyside and Cheshire are staging their second 24-hour strike in a week.
Last Thursday some 200 technicians and high dependency staff walked out in a row over the government's re-organisation of NHS pay bands.
Tuesday's strike action follows a failed meeting on Friday between unions and managers to resolve the dispute.
Technicians - who assist paramedics - fear the restructure will lead to a pay cut, as well as lost bonuses.
The new system introduces a new basic salary with additional payments for working unsociable hours but the Ambulance Service Union believes the change equates to a cut in the hourly rate paid to technicians.
However, North West Ambulance Service NHS Trust said it has pledged a million pounds to develop the skills of about 90 technicians to allow improvements in salary over a period of time.
Paramedics are not involved in the strike action.