Jeremy Hunt has been accused of "megaphone diplomacy" after making a last-ditch offer to win over junior doctors ahead of a strike ballot in the increasingly bitter working hours dispute.
The Health Secretary has written directly to every trainee in England, setting out details of a proposed new contract that would see basic pay rise by 11% and restrict hours to "make care safer for patients".
But junior doctors' representatives said there could be no meaningful negotiation over the new proposals unless Mr Hunt withdrew his threat to impose the new contract on medics without agreement.
Under the new proposals the average working week will still be 48 hours, and the maximum will be reduced from 91 to 72.
Although Mr Hunt is standing by plans to stop the whole weekend being treated as "anti-social hours", he has made a limited concession by offering additional pay after 7pm on Saturdays and Sundays - rather than 10pm as previously mooted.
The Health Secretary said his door was open to the British Medical Association (BMA) but blamed the doctors' union for refusing to return to the negotiating table.
Mr Hunt defended the new offer: "Any doctor working within the legal maximum safe hours will not be worse off. There are about 500 doctors who are working outside the legal safe hours and for those doctors we think the right thing to do is actually restrict the hours they work, so they are giving safe care for patients.
"One of the important things about the proposals we are making today is that they will make care safer for patients.
The Health Secretary said the plans were aimed at creating a truly seven-day-a-week NHS and insisted the threat to unilaterally impose the contract was necessary.
He told BBC Radio 4's Today programme: "We have been talking to the BMA politely for three years now about how we deal with this weekend effect where we have had six studies in the last five years that have shown that we have higher mortality rates at the weekend then we would expect."
The move to a seven-day NHS was a key Tory election commitment, he added.
"We do need to deliver the manifesto promise that we made to the British people and we are not going to wait another three years whilst we have these problems at weekends that we want to solve and make sure that our NHS really is able to deliver the highest quality, safest care."
Johann Malawana, chairman of the BMA's junior doctors committee, condemned the way the offer had been made at the last moment ahead of the ballot on industrial action.
"This is effectively megaphone diplomacy. The Government has decided at the 11th hour - they have had weeks, months, years to engage with us seriously - and on the last night before a ballot is opened they have decided to put out a contract proposal.
"That tells you what this Government is trying to actually achieve."
He said Mr Hunt was being "unfair" and added "it says a lot about how the Secretary of State has handled this over the last three months".
Dr Malawana told Today: "In order to have meaningful discussions you need to remove the threat of imposition and you need to actually address the concerns that junior doctors have, and we need a commitment from the Secretary of State to do that."
He said a "professional negotiation" was needed to deliver a contract that was "safe for patients and doctors".
Ministers want to scrap the complicated "banding" system, which builds up earnings based on responsibilities, hours worked and how often they are on call.
But they are proposing to offset those sums with the hike of around 11% in basic salary, together with supplements such as for being on call, working out of hours, and premiums for working in disciplines with staff shortages.
Flexible pay premiums would be applied to more specialities than just general practice and A&E care - acute medical ward staff and psychiatrists benefiting.
Mr Hunt claimed the revised proposals would mean pay increasing for 75% of doctors.
The BMA is preparing to ballot its members about industrial action over the busy Christmas period - potentially disrupting key services, routine operations and clinics.
After a wave of well-attended protests against the changes, trainees are widely expected to back some kind of withdrawal of labour.
Professor Sir Bruce Keogh, medical director for NHS England, urged doctors to consider the terms being offered.
He said: "Junior doctors are essential to the functioning of the NHS and the clinical leaders of the future. A strike is ultimately in no-one's interest, so I urge all junior doctors to please pay careful and considered attention to the new contractual offer set out today which if implemented correctly will address the long hours and related safety issues which have been such a cause for concern.
"However, the only way to get this right is to talk, because getting the detail right will mean better options for those who deliver care and, consequently, safer care and better outcomes for our patients. It is particularly important for our patients and professional integrity that no action compromises urgent or emergency care in any way."
NHS Employers chief executive Danny Mortimer said he had written to Dr Malawana with details of the proposal, insisting the new offer was "fair and safe for patients and doctors".
"We want to work with the BMA now to agree the final details of the contract by the New Year," he said.
Professor Hugo Mascie-Taylor, medical director at health regulator Monitor, and Dr Kathy McLean, medical director at the NHS Trust Development Authority, called on the BMA to return to the negotiating table.
"A shorter working week, limits on the number of consecutive long shifts and regular work reviews, if properly implemented, should lead to better working arrangements for doctors and therefore the patients they care for," they said.
"Junior doctors understandably feel strongly about their contract and it is in their interests to be part of the conversation on what their contract will look like in the future – we urge them to return to negotiations.
"This approach, we consider, would be in the best interests of all parties - perhaps most of all those of our patients, to whom we know junior doctors are fully committed."