Unions have deemed a 5 per cent pay offer for NHS staff "disappointing" despite it being a record pay deal from the government.
The Scottish Government deal for NHS Scotland Agenda for Change staff would benefit 160,000 employees, but unions described it as a "real-time pay cut".
Unison has called for an above-inflation pay rise to ease pressure of the cost-of-living crisis on health workers.
The government said it was the largest single-year increase since devolution.
Under the deal, workers would receive between £1000 and £2400 depending on their roles and experience. All Agenda for Change staff would be paid at least £10.50 per hour.
The offer would be backdated to April 1 but Unison Scotland regional manager Kay Sillars said it would be a blow to workers amid rising living costs.
She 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 6500 nursing vacancies across the country and offering health workers another real-terms pay cut is only storing up future problems for the NHS.”
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The GMB union said it could not recommend members accept the offer.
"Ministers need to go further on pay for these key workers," Scotland organiser Karen Leonard said.
"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."
However, Health Secretary Humza Yousaf claims that the Scottish workforce has the best pay conditions in the UK.
He said the offer 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 said: "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.
“Following constructive discussions with unions and employers, we are offering the biggest single year NHS pay uplift since devolution."
The deal would see experienced porters receive an uplift of £1000 and a healthcare support workers would receive £1200.
Wilma Brown, chair of UNISON’s Scottish Health Committee, said: "This pay offer falls well below the current level of inflation and is a real-terms pay cut for health workers.
“Our members will want to know why NHS staff on the highest pay bands will receive a rise of more than £5,500 per year while hard working domestics, porters, nursing assistants and others on the lowest bands are only deemed to be worth circa £1,000 per year.
“We have made it clear to the Scottish Government that our members will be disappointed and we will now be consulting our members on next steps. We would urge all of our members to look out for their ballot in the coming weeks.”
The Royal College of Nurses (RCN) also said it "falls short" of its expectations of a fair pay award.
Chair of the union's Scotland board Julie Lamberth said: “This offer falls far short of our expectations of a fair pay award.
"Our members demonstrated their worth many times over during the pandemic.
"They have put their own health and wellbeing on the line day after day, month after month. They continue to do so as we move into remobilisation and recovery.
“We will consider the detail of the offer and how to consult members on whether it is acceptable to them. Ultimately, it will be our members who have the final say on whether or not this pay offer makes the grade.”
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