Nurses have given the government five days to open "detailed negotiations" on pay, or they will announce strike dates for December.
It comes as the chancellor pledged an extra £2.3bn for the next two years for the NHS, as the health service grapples with inflationary pressures.
NHS England had forecast a £7bn shortfall in its funding next year which it cannot plug with efficiency measures alone.
However, health bosses are understood to agree the new funding is adequate against a backdrop where economists hope October’s inflation figure was the peak.
Last week, the Royal College of Nursing (RCN) announced its members at the majority of NHS employers across the UK had voted to take strike action.
A health system in crisis
In a letter to the health secretary following Thursday’s autumn statement, RCN general secretary and chief executive Pat Cullen said recent meetings with Steve Barclay, while cordial in tone, had not resolved the issues at the heart of strike action.
"I must not let my members, nor the public confuse these meetings for serious discussions on the issues of NHS pay and patient safety," she said in the letter.
"There is only value in meeting if you wish to discuss – in formal, detailed negotiations – the issues that have caused our members to vote for strike action."
She added: "You have again asked to meet in the coming days and for this third occasion I must be clearer in my expectation."
With record demand and waiting times, as well as a growing backlog ahead of what looks set to be a busy winter, the UK’s health and care system are facing a crisis.
There are nursing staff shortages across the UK – made worse by the COVID-19 pandemic and cost of living crisis – with 60,000 unfilled nursing roles.
Data from the London School of Economics found the salaries of experienced nurses have declined by 20% in real terms over the last 10 years across most of the UK. This means nurses are effectively working one day a week for free.
The RCN is calling for a pay rise of 5% above inflation to combat this.
Strikes across the NHS
The RCN is not the only organisation threatening strike action within the NHS.
NHS workers in roles such as blood and transplant services were among nearly 10,000 people being balloted over action that could see them walk off the job as soon as January.
Unite union, which represents 100,000 NHS workers, said voting papers are going out across 36 NHS trusts and organisations in England and Wales.
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