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Scotland's largest union for NHS staff is to consult its members over a "disappointing" 5% pay offer from the Scottish government.
Unison had called for an above-inflation pay rise to reflect the cost of living crisis.
The union described the offer as a real-terms pay cut for health service workers.
Depending on roles and experience, the government said frontline workers would receive pay rises ranging from around £1,000 to £2,400.
All staff would be paid at least £10.50 per hour, with the offer backdated to 1 April.
Kay Sillars, Unison Scotland's regional manager, said: "This will come as a blow to health workers who are already struggling to make ends meet as day-to-day living expenses continue to rise.
"Achieving a significant pay increase is essential to support the retention of current staff and to stem the flow of staff leaving NHS Scotland over the next year.
"We already have 6,500 nursing vacancies across the country and offering health workers another real-terms pay cut is only storing up future problems for the NHS."
'Recruit and retain'
The GMB union also said it could not recommend that its members accept the one-year offer.
Scotland organiser Karen Leonard said: "Ministers need to go further on pay for these key workers.
"Frontline NHS services are chronically under-staffed and if we want to improve this for patients then we need to recruit and retain the people needed to deliver them, and that starts with proper value.
"In the grip of the biggest cost of living crisis in 40 years, we cannot recommend to our hard-pressed members the acceptance of a deal that doesn't sufficiently confront soaring inflation and eye-watering energy bills, or a funding settlement that awards the most to the highest earners."
The potential pay dispute comes as the Scottish government is involved in similar negotiations with other public sector staff, including rail workers in the newly-nationalised ScotRail and local authority workers, who are being balloted for strike action in August.
Scotland's health secretary, Humza Yousaf, said the 5% offer to NHS staff was "a demonstration of how much we value our NHS staff who have worked tirelessly to keep us safe during the course of the pandemic".
He added: "Our NHS Agenda for Change workforce - like nursing and midwifery staff, porter staff, and therapy staff - have long had the best pay and conditions in the UK, and with today's offer of a 5% pay rise we're demonstrating our commitment to ensuring that continues to be the case.
"Experienced porters will receive more than £1,000 extra, while a healthcare support worker will see more than £1,200 extra. Experienced nurses will see their pay rise by more than £1,600 and an experienced advanced nurse practitioner will receive almost £2,400 more.
"In fact, as we're building on NHS Scotland staff being the best paid in the four nations, the UK government would need to deliver pay uplifts of between 6% to 14% to front line NHS England Agenda for Change staff to catch up with pay levels in Scotland.
"This has been another exceptionally challenging year for our health service and I am pleased that the Scottish government is able to recognise the service and dedication of our healthcare and support staff. We will be forever grateful for their professionalism and care."
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