Health union leaders have reacted furiously to a warning from Rishi Sunak that his offer of a 6% pay rise this year was final and that “no amount of strikes” would change his mind, as they began their longest walkout yet in England. The British Medical Association said the government was “driving doctors away” from the health service and had missed an opportunity to put a credible pay offer on the table to end strikes when it accepted all the recommendations of the pay review bodies. The Royal College of Nursing (RCN), whose members were offered 5% under separate NHS negotiations, accused ministers of taking a “cavalier” approach to pay when 100,000 nurses had voted to continue strike action in the latest ballot. “Today’s news will only add to that number,” it said. The government has been contending with the most widespread public sector strikes in decades as workers demand higher pay to make up for previous below-inflation rises or freezes, and to help them through the cost of living crisis. Health services, including surgery and outpatient appointments, have all been hit by the unprecedented five-day junior doctors’ strike that began on Thursday. Consultants are due to take industrial action next week. Millions of public sector workers in England including teachers, police officers and prison officers were offered a pay rise of between 5% and 7% on Thursday, but, as the Guardian revealed on Tuesday, Whitehall departments have been told to fund the rise from existing budgets. In a boost for Sunak, however, education unions said they were recommending teachers accept their 6.5% offer, which came with a guarantee that it would not be funded from the existing schools budget but from elsewhere in the department. At a Downing Street press conference, Sunak confirmed that public sector pay rises in 2023-24, which would cost £2bn extra this year, would be funded from “savings and efficiencies” in existing departmental budgets and not from more government borrowing, which might have fuelled inflation. Imploring striking public sector workers to end their industrial action, he said: “Today’s offer is final. There will be no more talks on pay. We will not negotiate again on this year’s settlements. And no amount of strikes will change our decision.” As the longest strike in NHS history got under way, the prime minister claimed the pay offers could be funded without hitting frontline services, and told doctors to “do the right thing and know when to say yes”. The highest pay rise, 7%, will go to police officers, funded partly by the Home Office increasing the cost of work and study visas for immigrants. A reduction in hiring civil servants in the Ministry of Defence until 2025 will be used to meet a 5% pay rise for armed forces personnel. The immigration health surcharge, a fee for foreigners to access the NHS, will be increased from £624 to £1,000 to cover the extra 6% pay for junior doctors. Prison officers will get a 7% increase, while senior civil servants will get 5.5%. The visa fees and NHS surcharge will raise around half the extra £2bn needed to fund the pay rises, with the rest coming from departmental “underspend” and “reprioritising” other spending. The education department, for example, is scaling back skills bootcamps and traineeships for officials. The government’s proposed 6% pay rise for junior doctors, plus a £1,250 payment, falls substantially short of the 35% wage increase demanded by the BMA to reverse what it claims is 15 years of wage erosion. The chair of the BMA’s UK council, Prof Phil Banfield, said that though doctors remained “willing to talk”, the pay offer meant they were likely to continue with industrial action. It was also “highly likely” that GPs and speciality doctors “will consider their next steps”. “This government is driving doctors away from the NHS and this country; it needs to wake up and realise the true cost of keeping the expertise of doctors,” Banfield said. “It missed a huge opportunity to put a credible proposal on the table to end strikes. “This uplift still fails tens of thousands of frontline staff and is unlikely to do much to help retain a beleaguered, burnt out, undervalued workforce.” More than 1 million NHS staff, including nurses, porters and ambulance staff, have already been offered a 5% increase by the government for 2023-24, along with a one-off payment for last year, under the NHS’s agenda for change contract. The RCN, which is considering whether to ballot members again after failing to meet the turnout threshold last month, although a majority of those who did vote supported further action, criticised the government for failing to offer them more. Pat Cullen, the RCN’s general secretary, said: “The prime minister will have to explain to over a million outraged NHS workers why they are getting the lowest pay rise in the public sector. “Record numbers of jobs in the NHS are unfilled and the government cannot expect to turn that around when it appears not to value them. Patients are paying the price. “Inflation is not coming down in the way ministers told NHS staff and others it would. For nursing staff, the pay rise they actually rejected is worth increasingly little and being eclipsed now by announcements for other professions. It is unfair and inadequate. “This seems a highly cavalier approach by government when it knows over 100,000 nursing staff across the country voted to continue strike action only days ago. Today’s news will only add to that number.”