Members of the GMB union who work in the NHS in Scotland have rejected the Scottish Government's latest pay offer.
The union, which represents Scottish Ambulance Service staff, nurses, porters and radiographers, voted by 66 per cent to 33.9 per cent to refuse the deal.
Scottish Government ministers put a new offer on the table which would have seen workers receive on average a 7.5 per cent pay rise.
Following the offer the GMB suspended a planned ambulance strike at the end of last month while its members took part in a consultative ballot.
Unite and Unison members voted to accept the deal, while the RCN and Chartered Society of Physiotherapy (CSP) members are currently being consulted.
Keir Greenaway, GMB Scotland Senior Organiser for Public Service, called on the Government to get round the table to negotiate a new deal.
He said: "The result reflects our members views and the realities of this offer. It is still below inflation for the vast majority of staff, who worked through the depths of the pandemic and are struggling in the grip of this cost-of-living crisis, and it doesn’t go far enough in itself to confront the understaffing crisis affecting frontline services either.
"The Scottish Government has contrasted its approach on trade union engagement with that of the UK Government, so we are now asking the Cabinet Secretary to practice what he preaches by meeting our members this side of Christmas to continue discussions over their value and the sustainability of their services.
"It is important the Cabinet Secretary takes on board the views of all NHS staff and not just some, because we are talking about frontline workers who understand first-hand the crisis across service delivery and patient care, and they have clear and credible views on how these services can be recovered in the months and years ahead.
"The fact remains that GMB members in major services and health board areas have strong legal mandates for strikes and an imposition of this offer without further discussion would be seriously detrimental to the industrial relations the Scottish Government have been quick to promote.
"If the Cabinet Secretary wants to preserve those relations, he must meet our members urgently."
Where could GMB members strike?
The GMB has mandates for industrial action in the following health boards and services: Scottish Ambulance Service, Greater Glasgow & Clyde, Lanarkshire, Lothian, Forth Valley, Borders, Western Isles, ISS Mediclean UK (Hairmyres Hospital), Golden Jubilee University Hospital, Health Care Improvement Scotland, Education Scotland.
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