Typing of hospital documents at Barnet and Chase Farm Hospitals will not be outsourced to companies in India, health bosses have decided. But staff are now concerned their roles may be downgraded, with accompanying pay cuts.

After an initial staff consultation at the end of July, bosses decided not to outsource administration, which would have used voice dictation sent by doctors via email to be typed up abroad.

A spokesman said the trust was now consulting on introducing an in-house reorganised typing service.

"There was overwhelming opposition to the outsourcing of typing and we engaged in consultation with our staff, who felt that they could do the typing."

But now medical secretaries - who currently type up all notes of appointments between patients and consultants, deal with patients and answer phones - are now having to apply for the position of personal assistant (PA) or as one of 22 typists in a pool. The PA position commands a higher salary than medical secretary, but the typist job would mean a pay cut. One medical secretary, who did not want to be named, said: "Morale is awful - you wouldn't comprehend the stress and the feelings of the staff, it's so worrying.

"We are also worried about patient care. If you are a PA rather than a medical secretary you aren't going to know what's wrong with some of the patients, because you are not typing the appointment notes. It's going to be a disaster and everyone knows that except the trust."

The second consultation finished at the end of September and a decision is expected in the next few weeks.