Leaders of 100,000 health service workers today rejected the Government's final offer on pensions, dealing a blow to hopes that the bitter dispute could soon be resolved.
Unite said its health sector national committee unanimously rejected the proposed deal as a basis for a satisfactory outcome to the long-running row.
General secretary Len McCluskey said the committee had turned down the Government's "pernicious attempts" to make hard-working NHS staff pay more, work longer and get less when they retire.
The move followed a decision by the British Medical Association (BMA) to survey around 130,000 doctors and medical students on the Government's final offer, raising the prospect of their first industrial action ballot for over 30 years.
The BMA said it will seek the views of its members on whether the proposed deal is acceptable, and if not, what action they would be prepared to take. The BMA said a formal ballot on industrial action could follow.
Meanwhile, leaders of the NASUWT teachers' union will meet tomorrow to consider the pension proposals amid speculation that they will also reject them.
Up to two million public sector workers went on strike on November 30 in the biggest outbreak of industrial unrest since the 1979 Winter of Discontent.
The Government later made a final offer after a series of intensive talks with unions, leading ministers to say they hoped the dispute could finally be resolved.
The Public and Commercial Services union immediately rejected the proposed deal, and a number of unions said they would take the offer back to their executives before deciding whether to accept.
Mr McCluskey said: "The Government's attacks on public sector pensions are politically-motivated, as part of an overall design to privatise the NHS, cut public services, break up the national pay agreements, and disrupt legitimate trade union activities and organisation.
"Unite believes it is important to continue a campaign to maintain a fair and equitable system of public sector pensions and calls on ministers to enter into real, genuine and meaningful negotiations on the future of NHS pensions and public sector pensions."
Unite said a high proportion of NHS staff will see their pension contributions jump from the current 6.5% to 9.3% by 2014/15, and other staff will see their contributions increase by nearly 50%, with some paying 14.5% of their salary into their pensions.
The union said it also had concerns about the linking of the NHS retirement age to the ever-increasing age that people will receive their state pensions, warning that paramedics and nurses could be doing heavy lifting work into their late 60s.
Officials added that the proposed accrual rate for NHS staff was worse than the planned rates for other public sector schemes, saying that because this will be based on career average earnings, it will hit women who took career breaks to raise their children hardest.
The BMA, which last took industrial action in the mid-1970s over junior doctors' working conditions, did not take part in last year's strike.
The association said today that even though improvements had been made to the original offer, doctors would still be "hit hard", with those at the start of their careers facing the prospect of paying more than £200,000 in additional lifetime contributions.
Many doctors would have to work until they were 68 before being able to draw a full pension, while the amount deducted from their pay will go up from April, with further rises in 2013 and 2014.
Dr Hamish Meldrum, chairman of the BMA Council, said: "We want doctors and medical students to be fully aware of what's coming their way, and to have their say on what happens.
"Everyone will be affected, and it's up to the whole medical profession to influence what we do next. Either way, the implications are huge. We face either major, damaging changes to our pensions, or the first ballot of doctors on industrial action since the 70s.
"The BMA, along with the other unions, has not accepted the offer. That, quite rightly, is for our members to help decide. Throughout intensive negotiations, we repeatedly pointed out that the NHS pension was radically overhauled only three years ago, and is actually delivering a positive cashflow to the Treasury."
A Health Department spokesman said: "The BMA are co-signatories to the NHS Pension Scheme Heads of Agreement. The health trade unions including the BMA agreed to take the main elements of the scheme design to their members as the best that can be achieved.
"The unions have committed to suspend any industrial action while final details are resolved and members are consulted.
"We hope that BMA and its members will recognise that the Government has made an offer which is fair and sustainable in what is a very difficult economic climate and support the agreement reached. Further discussions are being held to work on the remaining details."
The NASUWT stressed ahead of its meeting tomorrow that its negotiators did not sign up to the Heads of Agreement proposals put forward by the education department last month.
"The national executive will be reviewing the discussions which took place and considering the next steps," said the union.