The GMB union, which represents ambulance workers and other staff, announced its members were in favour.

This means it is now highly likely a majority of the 14 NHS unions will give the deal their backing when they meet ministers next week.

But both the Royal College of Nursing and Unite strikes would continue as their members have rejected the deal.

The GMB results follows yes votes by unions representing midwives and physiotherapists earlier this week.

Some of the smaller unions, representing dieticians and prison health staff, have yet to declare.

But union sources say it is "almost certain" that at a meeting of the NHS Staff Council the deal will be ratified, prompting the government to sanction the 5% pay increase and one-off payment of at least £1,655 for 2022-23.

Rachel Harrison, GMB national secretary, said the union would now vote to accept the offer at Tuesday's meeting of the NHS Staff Council.

She added: "Our members recognise that progress has been made - from the Government originally offering nothing, health workers will be thousands of pounds better off.

"It also meets a key GMB demand of a huge pay uplift for the lowest paid, lifting them above the Real Living Wage.

"But so much more needs to be done for workers if we are all to get the NHS we need."

The turnout for GMB was 51% of members, with 56% of those accepting the deal.

The same pay offer was made to all NHS staff on Agenda for Change contracts - which include most workers apart from doctors, dentists and senior managers.

Unison, the largest NHS union, which represents ambulance crews, and a smaller number of other staff including nurses, has voted to accept the offer.

But nurses with the Royal College of Nursing (RCN) have rejected it and they plan more strike action, starting on Sunday at 20:00 BST in England.

Local strikes involving Unite members who are ambulance workers in Yorkshire will happen on Monday, with the south of England and West Midlands following on Tuesday.

Industrial action will also take place in some hospitals in London, Manchester, Lancashire and the West Midlands.

What does this mean for the NHS pay dispute?

The yes vote from the GMB is significant. There are 14 unions being asked to approve the pay deal with ministers having agreed to introduce it if the majority back it.

The unions vary hugely in size from the biggest two, Unison and the RCN, which both have close to 300,000 members on Agenda for Change, to the smallest ones representing eye specialists and dieticians with just a few thousand.

Therefore, voting at next week's NHS Staff Council meeting will be weighted.

With RCN members rejecting the deal and Unison ones accepting it, it came down to what would happen with the other unions - and in particular the middle-sized ones of Unite, the GMB, the Royal College of Midwives and the Chartered Society of Physiotherapy.

Earlier this week the midwives and physios backed it, but then on Friday Unite rejected it.

The GMB result means a majority vote in favour, meaning progressing with the pay deal is now highly likely - although this will not be confirmed until Tuesday.

Will that bring an end to the NHS pay dispute? The RCN is still free to re-ballot its members to get another strike mandate - and it has said it will once this weekend's walkout is over.

But that vote will be taking place just as nurses are getting a pay rise and a four-figure one-off lump sum - under the terms of the deal the money is paid to all Agenda for Change staff or none.

What is more, the way the vote is being organised - a national ballot rather than series of local workplace ballots - means it will be harder for the RCN to get over the threshold needed for strike action to take place.

This deal does not directly affect the dispute with junior doctors - they are on a different contract.

But it certainly puts pressure on the British Medical Association if many lower paid NHS staff are willing to accept a pay that gets nowhere near its 35% pay claim.