A DISPUTE which could bring Scotland's biggest hospital trust to its knees in three weeks is spreading through the rest of the country.

As nearly 300 medical secretaries at North Glasgow Trust prepared to give notice of a strike ballot, union leaders yesterday were anticipating similar action by staff at Lanarkshire Acute Trust.

Medical secretaries from Lothian, Grampian and Tayside have also written to Unison with the same grievance over pay scales.

''This issue is exploding all over Scotland,'' said Jim Devine, the union's Scottish officer for health.

''I will be meeting representatives from Lanarkshire Acute on Tuesday and I expect to be confronted by a lot of angry workers. The issue has dragged on since last June, when 165 medical secretaries raised grievances.''

Meanwhile, a leading surgeon said the secretaries at North Glasgow Trust - who are likely to give formal notice of a strike ballot when the deadline they have set expires next week - had overwhelming support from his consultant colleagues.

Professor Clem Imrie accused hospital managers of hypocrisy for paying their own secretaries more than the medical secretaries, who have to master complex medical jargon and deal with sick and worried patients.

Grade three, on which medical secretaries are paid, goes from #10,643 to #12,358 while grade four, covering management secretaries, rises from #12,358 to #14,991.

A sample list of duties specific to medical secretaries runs to nearly two pages and may include arranging patients' admissions, cancelling them at short notice, and writing discharge notes.

This requires great accuracy as it can involve drugs, dosages and other information which could affect the patient if it was transcribed wrongly.

Professor Imrie, an internationally-renowned expert on pancreatic disease, based at the Royal Infirmary, said: ''The feeling across the trust is running very high.

''I have not spoken to a single consultant who would not be behind the medical secretaries.''

As long as seven years ago, Professor Imrie wrote to every consultant in the city asking if they knew how much their secretaries were paid.

''Three-quarters of them were completely unaware of how poorly they were paid,'' he said. ''Yet their industrial muscle is colossal.

''If they struck for three days we would be paralysed.

''There would be no theatre lists, no clinic lists. We would shut down. Even a quarter of them going out on strike could stop a huge amount of hospital activity.''

He said what upset him was the injustice of managers putting their own secretaries on grade four in the Whitley Council pay scales, and the medical secretaries on grade three.

He said: ''If you hire someone who is better trained they should get more reimbursement, but the opposite is the case.

''Skills not held by others are held by these people but they are being downgraded. The injustice and the unfairness is what bothers most people.''

Professor Imrie added: ''It has been the usual thing. Management have had the muscle and exercised it, and the secretaries have it but have not used it.''

Carolyn Leckie, the union's branch secretary for North Glasgow, said: ''If they went on strike the impact on elective surgery, waiting lists, waiting-time initiatives and out-patient treatment would be enormous, but we would not frustrate the treatment of life-threatening emergencies.''

The Scottish Executive made clear it was up to individual trusts to decide which pay scales their staff were in - a situation which Mr Devine described as totally unsatisfactory. ''We need a Scottish solution for this problem,'' he said.