Some 35,000 NHS workers could lose their jobs if staff do not accept further pay conditions, it has been reported.
Staff earning up to £34,189 who have already had their pay frozen for two years are now being asked to give up the annual increments they receive in order to save jobs, according to The Observer.
NHS Employers, which represents primary care trusts and other providers, plans to cut 35,000 jobs if the proposals are rejected, the Sunday newspaper reported.
Increments were previously excluded from the original public sector pay freeze, which affects all but those earning less than £21,000, and are worth up to a few thousand pounds a year.
Ending them for two years would, NHS Employers calculates, save £3.8 billion as part of the effort to secure £20 billion of efficiency savings in the health service by 2014/15.
Karen Reay, National Officer for Health at the Unite trade union, told the newspaper: "If you don't accept these swingeing proposals, other people may lose their jobs. This is a blunt threat by employers and a negatively emotive way of trying to do business.
"Staff who are loyal to the NHS and aren't paid too much to start with are now being asked to take another hit. It's unfair. Many are angry that, after the two-year pay freeze, they are expected to lose their pay increments for two years as well."
The deal was first proposed earlier this week, with doctors' leaders saying it exposed government claims the NHS budget was being protected were false and expressing doubts about the offered job loss guarantee.
"This proposal makes clear that the NHS is in fact facing a real-terms cut in funding over the next two years and it appears NHS staff are expected personally to bridge the funding gap in some way," Hamish Meldrum, Chairman of British Medical Association Council said in a letter to members.
The guarantees "appear to be very limited and will be left to local agreement", he noted.
A Department of Health spokesman was not immediately able to confirm the 35,000 figure.
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"In general practice many practices have had no pay rises for the past three years or incremental rises, we have not had those since we went agenda for change. This is not new to the real front line" - Mike, South Yorkshire