Members of the third largest trade union in the NHS have voted overwhelmingly to reject the government's three-year pay deal for health sector workers, which is worth less than 8%.
Unite said that 94.8% of members, including health visitors, medical practitioners and mental health nurses, voted to turn down the 7.99% offer. They also voted for a ballot on industrial action.
Unite's assistant general secretary, Gail Cartmail, said the vote sent a "clear message". "Our members are angry and frustrated that they are being asked by the government to accept this woefully inadequate three-year pay deal," she said.
"Unite members believe this pay deal is in effect a substantial pay cut when you take into account the inflationary trends in the economy, such as soaring petrol prices, increased mortgage payments and runaway utility costs."
The union said it was concerned that the current pay offer will damage NHS morale, recruitment and retention.
"This unprecedented call for a ballot for strike action must be heard," Unite health sector national officer Karen Reay said.
"Services will suffer and demoralisation will result in an inability to recruit and retain essential NHS staff."