Three key health unions are to ballot their members in England on industrial action, including strikes, over pay.
Unison, the Royal College of Midwives and Unite announced they would be taking the step over the pay offer made in March. It is the first time midwives have been balloted in their history.
Ministers said NHS staff would get 1%, but it would not apply to those who get automatic progression-in-the-job rises.
These cover about half of staff and are worth 3% a year on average.
They are designed to reward professional development.
But the decision by ministers went against the recommendation of the independent pay review board, which had called for an across-the-board rise.
In Scotland, the recommendation was agreed to in full. Northern Ireland is yet to make a decision, while Wales is doing the same as England but has given extra money to the lowest paid.
'End of their tether'Unison has about 300,000 health members, including nurses, therapists, porters, paramedics, medical secretaries, cooks, cleaners and healthcare assistants, while 26,000 midwives are being balloted.
Unite is balloting nearly 90,000 members, including those in Northern Ireland and Wales.
If they vote yes to industrial action, it is likely to start in October.
Unison head of health Christina McAnea said: "Balloting for strike action is not an easy decision - especially in the NHS. But this government is showing complete contempt for NHS workers."
Cathy Warwick, chief executive of the Royal College of Midwives, added: "Midwives are at the end of their tether."
The main nursing union, Royal College of Nursing, has decided not to ballot members over industrial action.
Instead, its general secretary, Peter Carter, has urged his members to campaign against the pay deal, including targeting MPs in marginal seats in the run-up to the election.
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