Lorry drivers could take strike action in a pay dispute that could disrupt NHS supply chains.
Nearly 200 drivers employed by GXO, including those based in Bury St Edmunds who deliver NHS general equipment and supplies to hospitals across the country, are taking part in the vote, organised by Unite.
GXO manages the NHS supply chain contract for Supply Chain Coordination Limited (SCCL), which is wholly owned by NHS England.
Sharon Graham, general secretary at Unite, said: "GXO and SCCL’s offer was met with a near unanimous rejection by workers.
"It must be improved."
The drivers, who operate HGVs and other vehicles, have already rejected a four per cent pay offer from GXO.
The company has said the offer cannot be increased because it exceeds the rise given to NHS staff.
A GXO Spokesperson said: "Unite has notified us that it intends to ballot certain driver colleagues working on the NHS Supply Chain contract.
"We remain committed to constructive discussions with union representatives and ACAS and have made a fair and competitive pay offer to our colleagues.
"The ballot process is ongoing and no industrial action has been confirmed. Should industrial action be confirmed, we have plans in place to mitigate any potential disruption and maintain continuity of service."
However, Unite argues that GXO workers are on far worse terms and conditions than those directly employed by the NHS, including a much less favourable pension scheme.
Ms Graham said: "Unite is backing these workers all the way in their fight for a deal that reflects their hard work and dedication."
The ballot for industrial action will close on September 17.
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Phil Silkstone, regional officer at Unite, said: "GXO and SCCL are forcing these workers towards industrial action.
"They will bear responsibility for any disruption caused to NHS supplies."
He added that the union remains open to negotiations.
Mr Silkstone said: "Strike action can be avoided, but that will require an acceptable offer being put forward."
The dispute involves drivers based in Derbyshire, Somerset, Kent, West Yorkshire, Warwickshire, Cheshire, Suffolk and Newcastle.
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