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The Guardian - UK
The Guardian - UK
Politics
Haroon Siddique and Jessica Elgot

Junior doctors' strike over pay and working hours – as it happened

Junior doctors on Lewisham picket line: ‘Devalued, demoralised, determined’

Summary

  • Thousands of junior doctors have gone on strike across England in a dispute over pay and working hours they claim will compromise patient safety.
  • The health secretary, Jeremy Hunt, said the dispute was “wholly unnecessary” and called for the British Medical Association to return to negotiations.
  • Some junior doctors claim they were “tricked” and “bullied” into returning to work while on strike after a West Midlands hospital declared a level four incident and called staff away from the picket lines.
  • Sandwell General hospital in West Bromwich said it needed more staff after unexpectedly high numbers of patients but many medics claimed the order had been pre-planned, because the letter recalling doctors was dated Monday but sent today.
  • The BMA said doctors in Sandwell should continue to strike until further notice and Dr Johann Malawana, chair of the BMA junior doctors’ committee, said the move was part of “last minute, inept and heavy-handed attempts to bully junior doctors”.
  • The hospital later stood down the order for doctors to return to work, but denied it had any political motivation to attempt to break strike action.
  • NHS England said 38% of junior doctors had turned up to work, although it later emerged the figure included those working in urgent and emergency care, who have been asked not to strike by the BMA. The numbers still in work were unsurprising, the union said.
  • Doctors attended about 100 picket lines across England, including holding ‘Meet the Doctors’ events in city centres to explain their reasons for striking.
  • The strike will finish at 8am on Wednesday but is set to be followed by further industrial action.
  • There is a scheduled 48-hour stoppage and the provision of emergency care only from 8am on 26 January. On 10 February, there will be a full withdrawal of labour from 8am to 5pm.

Updated

Most of the picket lines have disbanded as shifts for junior doctors working in emergency care start this evening. The strike does not officially finish until 8am tomorrow but doctors rostered on this evening will be in work as it qualifies as emergency and urgent care. The next planned strike is from 26 to 28 January.

A banner supporting the strike, near the Royal London hospital
A banner supporting the strike, near the Royal London hospital. Photograph: Kristian Buus/In Pictures/Corbis

Updated

Sandwell hospital stands down order for junior doctors to return to work

Sandwell hospital has said it is no longer necessary for junior doctors to return to the wards, after earlier ordering medics back to their wards because of a “level 4” incident that saw increased numbers of patients over the past couple of days, with fewer patients than usual discharged.

The BMA said medics should not return to work because such situations were a regular occurrence, not an emergency.

The West Midlands hospital’s chief executive, Toby Lewis, has now said:

Throughout today we have managed the increased numbers of patients admitted to Sandwell hospital in recent days.

The number we have been able to safely discharge has increased so that services are safe for tonight and tomorrow.

We have agreed with the LNC Chair to stand down the request to some trainee doctors at Sandwell hospital to come in and provide additional assistance. We will keep this situation under review.

Several junior doctors working for the trust questioned why the situation had been labelled an emergency, other than to undermine strike action. The hospital has fiercely denied it has any political motivation.

The statement says:

The trust is not party to the national dispute in any way. The decisions made were made locally, and based on judgments about current and foreseeable pressure – a recognised basis for incident management. It would be irresponsible to wait for a position that was not recoverable and then act.

I want to thank those people who did come in to work on the Sandwell wards today. There has never been any doubt here that, in circumstances of difficulty, individuals would prioritise patients.

Updated

NHS England said strike action meant it had been a tough day for patients but the disruption was not worse than expected.

Anne Rainsberry, the NHS’s national incident director, said:

As expected, unfortunately, this action has caused disruption to patient care and we apologise to all patients affected.

It’s a tough day, but the NHS is pulling out all the stops, with senior doctors and nurses often stepping in to provide cover.

We are actively monitoring the situation across the country and the impact of the action is broadly in line with what we were expecting.

NHS trusts are now working hard to reschedule cancelled tests, appointments and operations as soon as is possible.

Updated

Junior doctors protesting outside Great Western hospital in Swindon, have been joined by a patient, Tony Collins, who left his hospital bed to join the picket line.

Doctors at Great Western Hospital Swindon with patient Tony Collins
Doctors at Great Western hospital, Swindon, with patient Tony Collins. Photograph: Calyx/Rex/Shutterstock
Junior doctors protesting outside Great Western Hospital, Swindon
Picket line outside the hospital. Photograph: Calyx/Rex/Shutterstock

Updated

39% of junior doctors in work – including those providing emergency care

NHS England has confirmed 39% of junior doctors out of a possible 26,000 have reported for work, but said the figure included those working in urgent and emergency care who would not have been part of the strike anyway.

It means just over 15,800 doctors have not been on wards when they would have been expected to be.

The BMA asked doctors working in emergency and urgent care not to strike in the interest of patients.

The 26,000 figure is the number of junior doctors who would be expected to be in work on a typical day.

Updated

Sabrieh, a junior doctor for eight years, has been handing out leaflets to the public this morning outside Tooting Broadway station with her two small children. She said: “I love my job and we all care about the service we provide.

“Ultimately a lot of us are really concerned and made a lot of sacrifices along the way and it has a lot to do with morale and feeling undervalued and not listened to. I have used the NHS and have had two kids, and have family who will use it, and of course I’m going to defend it.”

Jessica Wills, a medical student in her fourth year, said people have been supportive, stopping by the doctors’ stall and sending them cups of coffee throughout the morning.

“As a medical student we can’t have an official say on this but ultimately this [will] affect us longer than any of the current junior doctors,” she said. “I have wanted to be a doctor since I was seven. What concerns me is there’s been an 11% decrease in applications [for medicine] – what we are now facing is not what we signed up for.”

Handing out stickers to passersby outside St George’s hospital, Miranda Lewis, a GP trainee who has been at the hospital for 18 months, said: “Today my ward has four consultants – so more doctors with experience, so I have no doubt patients will be looked after.

“Most of these people coming in are staff. Some came in before 8am to do checks.”

Updated

We reported earlier how some junior doctors had taken the opportunity while on strike to register as bone marrow donors. Others have been donating blood, according to these tweets.

A handful of junior doctors continued an unofficial picket in the rain on Westminster Bridge outside St Thomas’ hospital on Tuesday afternoon. James Crane, a diabetes registrar, said the atmosphere at the official picket this morning was “subdued but resolved”.

He said: “I think the DoH has been ignoring the real safety concerns of reducing the terms and conditions of our contract. Retention is a huge problem. We already struggle to maintain a work/life balance.

“The contract they’re trying to impose – the removal of severe financial penalties and safeguards and extending regular hours to Saturday – will only make that worse.”

St Thomas’ hospital staff James Crane and Fionna Martin
St Thomas’ hospital staff members James Crane and Fionna Martin. Photograph: David Batty for the Guardian

Crane said the worst case scenario would be if Hunt retained his entrenched position. He explained that, at the moment, if a hospital made junior doctors work excessive hours they could complain to the BMA and get additional monies paid from a fine imposed on the trust.

But under the new system the fine would go into a general account that the trust could use for staff training, which Crane said was not a sufficient penalty to deter excessive working hours.

Protesters cross Westminster Bridge outside St Thomas’ hospital in London
Protesters cross Westminster Bridge outside St Thomas’ hospital in London. Photograph: Philip Toscano/PA

His wife, Fionna Martin, who is also a registrar at the hospital, said the government’s plans might leave them unable to afford childcare for their two young children, Frances, four, and two-year-old Aneurin, named after Aneurin Bevan, the architect of the NHS.

Martin, a geriatric registrar, said: “I’m not standing here today because I don’t think the system doesn’t have to change but the imposition of working weekends and evenings would be a cut in my salary that is not sustainable.

“We don’t know what exactly it will be but it’s possible that we wouldn’t be able to afford childcare or our mortgage.”

Updated

Before Jeremy Hunt decided to break his silence on the strike today, broadcasters were instead offered an interview by the Department of Health, with medical adviser Sir Norman Williams.

It did not exactly go to plan. The reporter asks: “Where is Jeremy Hunt tonight?” to which Williams looks shocked and replies tentatively: “He’s in the Department of Health at his desk, working hard.”

A press officer intervenes. “Hang on a second, we’re not doing all this nonsense ...”

“Well, we’re recording this,” the journalist replied.

“We agreed a series of questions,” the press officer continued.

“I didn’t agree questions with anyone,” the reporter said. “In a democracy, I think we’re allowed to ask questions.”

Watch it in full here.

The BBC’s interview with Norman Williams

Updated

Here is another one of the many striking (no pun intended) images from today:

Updated

You can read more by junior doctors on why they are striking, here.

Here is a sample:

Dr Nina Beck, Bristol

The government are also still not providing concrete assurances that crucial safeguards will be in place to stop us working unsafe hours. They propose a ‘guardian’ to ensure safe contract hours, as opposed to the current financial penalty scheme if we are contracted to work unsafe hours. Unfortunately all of us who work in the NHS know nothing but financial penalties can ensure our safe working hours and ultimately the safety of our patients. This is analogous to putting a speed limit in an area but not enforcing it with points, fines or penalties. It wouldn’t work. Consider that when you’re talking about a line of work like ours, this may be the difference between life and death decisions for our patients. We won’t compromise on that, rightly so. I will not break my hippocratic oath to ‘do no harm’ as these contracts would see us do. The simple facts are this: who should the public trust? 54,000 doctors who commit their lives to helping others or a politician who has written a book on how to privatise the NHS? We would not be striking if we felt we had any other alternative.

Dr Rae Wake, junior doctor, London

There does seem to be some progress following the talks but on this issue of unsocial hours it feels like the government are digging their heels in for political reasons. They want to be able to say they achieved their manifesto of a ‘seven-day NHS’ but this poorly designed strategy will only create a disillusioned workforce ready to leave their profession and undermine the NHS further. They’ve got to listen to us on this.

Updated

Here is another fantastic photo from today:

Here is more from our indefatigable north of England correspondent, Josh Halliday, outside Manchester’s Arndale centre.

Updated

Junior doctors set up a “meet the public” stall outside the Arndale shopping centre in the heart of Manchester.

Dr Marianne Hilton, 36, described the new contract for junior doctors as a “step towards dismantlement of the NHS”. A qualified GP registrar since 2007, Hilton said the NHS is at breaking point and she no longer feels able to uphold the “do no harm” oath she took when she qualified. She said:

If it [the new contract] goes through I can no longer honour the oath I took to ‘do no harm’ – I’m exhausted and you don’t have the safeguards in place and you’re constantly bombarded with negativity by some of the media. It has become too much.

Aimee Priestman (left), 34, and Dr Marianne Hilton, 36
Aimee Priestman (left), 34, and Dr Marianne Hilton, 36 Photograph: Josh Halliday for the Guardian

Updated

Here is video of Jeremy Hunt in which he urges the BMA to return to the negotiating table and thanks the junior doctors who went back to work at Sandwell, saying: “That shows the values of the vast majority of junior doctors.”

Jeremy Hunt talking about the junior doctors’ strike

Updated

The BMA has said junior doctors who broke the strike at Sandwell hospital in the West Midlands, after the trust asked them to do so to help with extra demand, are likely to have faced significant pressure.

A spokeswoman said:

We know from the ground that not all junior doctors returned to work. Those that did were likely to have done so due to the pressure placed upon them. There was still however, a significant presence from junior doctors at the picket lines throughout the day.

Updated

The World Medical Association (WMA), which represents physicians from different countries, has backed today’s strike action.

The WMA president, Sir Michael Marmot, said it was the organisation’s policy that physicians might carry out protest action and sanctions in order to improve direct and indirect working conditions that might also affect patient care.

He added:

In this case it is clear that patient care would suffer in the long term if the government’s proposals to change the working hours of junior doctors goes ahead.

We note the widespread support given to junior doctors among the public and across the National Health Service and we would urge the British government to establish a new working relationship with junior doctors. It is essential that trust is restored on both sides for the sake of patient care.

During his interview with the World at One, Jeremy Hunt said “nearly 40% of junior doctors” had turned up to work today. But the BMA has explained why it is unsurprised by this figure:

Updated

Here’s a lovely card left with some muffins for striking doctors at Northumbria hospital.

Updated

Sandwell and West Birmingham Hospitals NHS Trust has issued a new statement saying it is still calling for striking doctors to return to work but hopes that by the end of the afternoon (the walkout is due to end at 8pm) they can stand down the “site recall”.

The trust says it acted because of “considerable and unusual pressure”, rebutting the idea that its move was a cynical ploy to break the strike. It also implied that a number of trainees did comply.

The chief executive, Toby Lewis, said:

The Sandwell site remains under considerable pressure with 15% additional beds open after a week of very considerable demand from sick patients needing our care. The trainee doctors that attended exceptionally, and those pre-agreed to be there, have helped greatly today, along with consultant colleagues, to de-escalate the site.

We are optimistic that towards the end of this afternoon we will have achieved our discharge aims. That will provide a safe hospital overnight and tomorrow and we can stand down our site recall.

It is important to be clear that today has not been a major incident, but has been one of considerable and unusual pressure and we have acted, on clinical advice, to ensure that the position does not deteriorate, become potentially unsafe and destabilising neighbouring hospitals and GP services.

Updated

A blog post from Roy Lilley, the blogger that people in the NHS take most seriously (including top brass such as the NHS England chief executive, Simon Stevens), excoriates Jeremy Hunt for his handling of the junior doctors’ dispute, sticks it to the BMA too (though less so) and depicts the bosses of NHS hospital trusts as important people rendered frustratingly powerless by events that affect them directly.

All the hospital bosses he’s spoken to – and he’s very well connected – “are sick to the back teeth of the dispute and want to know who’s going to pay for it. Trust boards are very cross”, Lilley writes.

Who does he blame? Jeremy Hunt, or the Tinkerman, as he likes to call him.

It seems to me, there are two main issues in play. First, the Tinkerman’s frustration that discussions about modernising the 2009 contract started back in 2012, got nowhere. Thus, he announced if progress wasn’t made he would impose a settlement. That was a really stupid thing to do. I have no idea who advised him to do that but they are to industrial relations what Jeremy Clarkson is to the caravan trade.

The second key issue?

The Tory election promise, to extend NHS working to seamless-seven-days, creates an imperative to change junior doctors’ out-of-hours/premium/overtime payments (call it what you will) to make it affordable within the existing cost envelope. This generates complexity around just how much they will earn and a working environment the docs don’t trust.

Ever robust in his views, Lilley sympathises with the bosses of hospitals, caught in the middle of a potentially protracted series of industrial action, whose job is difficult enough already. He says the end result of all this is that:

The row is about a political imperative (fair enough it’s a democracy), over which the employers have no say, who have been forced into a dispute with the workforce union they don’t want, who are railing against the Department of Health, who are not the employer, but calling the shots and the actual employer has to handle the fallout. Is that clear?



Updated

Here are some pictures submitted through GuardianWitness.

Picketers handing out free sandwiches to supporters during the junior doctors' strike at the Royal Sussex hospital in Brighton

The first industrial action in 40 years by Junior Doctors is overwhelmingly supported by the rest of the community in this deprived area of East London that would suffer greatly by unfilled positions and dangerous working practices if the Government's contract is imposed.

Pickett line at the RNOH in Stanmore, London. A small group, and it is bitterly cold but they are getting lots of public support which makes it easier!

An elderly woman leaves The Royal Liverpool Hospital through the picket.

Picket line outside Kent and Canterbury hospital

Outside South Kensington tube station in west London, dozens of junior doctors are gathered with placards from three famous local hospitals – the Chelsea and Westminster, the Royal Brompton chest hospital and the Royal Marsden cancer hospital. Every now and then a massive cheer goes up as drivers of passing cars beep in support.

The hospital consultants covering for the juniors have also been hugely supportive, said Lily Collins, an F2 junior working in community psychiatry at Chelsea and Westminster:

All the consultants have been so much behind us. They are the ones taking up the slack. They are doing our discharge summaries and saying we didn’t realise how hard you guys work.

But, she said: “It’s a misconception that we are not at work. It is the same level of cover as on Christmas Day.”

There are juniors who are on call, who are joining the picket line when they are not needed. Most of the public are very supportive, she said, but there had been a mixed reception. “You can’t expect everyone to be onboard, but we try to get them to understand the reasons.”

Maria Walsh, also in her second year out of medical school, working in anaesthetics at Royal Marsden, said the strike is about a patient safety issue: “I wouldn’t want to be operated on by someone who has worked a 12-hour shift.

“We are already overstretched. We work extra hours out of goodwill. It goes with the job.” But under the proposed new contract “there is nothing to stop the trusts overworking us”, she said.

The temperature had dropped and Collins was shivering. “But I’m going to be here until I’m too cold to survive,” she laughed.

Updated

Singers have been serenading striking doctors today:

National Health Singers serenade striking junior doctors

Updated

The picket at Sandwell, where junior doctors were ordered back to work, has now dispersed – the agreement was that they would stay until lunchtime. Doctors insisted they would have put down their placards and headed inside to help if there had been a genuine emergency. Some believe the trust was trying to trick them into going back to work.

Speaking at the picket line before they packed away, Dr Anne De Bray, who has worked at the hospital for a year, said:

My first reaction was to cry when they called us back in. I was really frustrated and sad that they were trying to call us back into work.

There have been quite a few letters over the past week explaining the measures they were going to take to cover the strike.

It’s been well planned. They said they would call us individually if they needed us to come back into work. Instead they’ve emailed us a letter that was dated yesterday (Monday) 15 minutes before our picket line was due to start. I just think they’ve not done it through the proper channels.

If there was a dangerous incident they should liaise with the BMA through NHS England to call off the strike. It’s really busy in there and staying in hospital for longer is not ideal for any patient.

If there had been a major incident like a terrorist attack or road accident we would drop our placards and head in. We have all brought out stethoscopes and a change of clothes.

But the BMA have said there’s no danger to patients. My team finished at 7pm three days last week, we were due to finish at 4pm. We do this and we don’t get paid for it.

Another junior doctor, who did not want to be named, added:

It is disgraceful they’ve tried to trick us back into work. The sad thing is some doctors would have fallen for it and gone back in.

There is no major incident. It is just busy which they have known about for a long time so they had plenty of time to put arrangements in place.

Updated

Laurence Topham has filed more video from the Royal London hospital in Whitechapel, east London.

‘We already have a seven-day NHS,’ says junior doctor Lizzie Williams
Medical students: ‘Our academic deadlines will have to wait’

Updated

Kearney pointed out that this is the first doctors’ strike in 40 years and asked Hunt if he felt responsible.

Hunt cited more examples of higher death rates at weekends. “I can’t in all consciousness ignore those studies, we’ve had three in the last two months. We have to do something about this. People get ill every day of the week,” he said.

Patient safety is not at risk by the removal of some of the current safeguards, like financial penalties for trusts that overwork doctors, he insisted. “Why would I want to do that? This new contract reduces the number of hours junior doctors are required to work. We actually offered to put in financial penalties.

“The BMA wanted the penalties to go to the junior doctors, and we say ... you’re creating a perverse incentive to actually work those hours that are too long.”

Updated

Jeremy Hunt says dispute 'wholly unnecessary'

“It’s very disappointing,” Hunt told the BBC’s Martha Kearney.

This is a wholly unnecessary dispute. We want all NHS patients to have the confidence that they will get the same high-quality care every day of the week.

At the moment, if you have a stroke at the weekends, you’re 20% more likely to die. That cannot be right, and that’s something every doctor wants to do.

The right thing to do is to sit round the table and talk to the government about how we improve patient safety and patient care, not these very unnecessary strikes.

Updated

The health secretary, Jeremy Hunt, is speaking for the first time today, to BBC Radio 4’s World at One. He urged junior doctors to get back to the negotiating table instead of continuing with “these very unnecessary strikes”, according to the trail at the start of the programme. We’ll be hearing more from him soon.

Updated

More than 150 pickets and related events - BMA

The BMA says there have been more more than 150 pickets and “meet the doctor” events across England. It has also condemned attempts to “bully” doctors back to work.

Dr Johann Malawana, the BMA junior doctors committee chair, said:

With junior doctors attending more than 150 pickets and ‘meet the doctor’ events up and down England, today’s action sends a clear message to Jeremy Hunt and David Cameron. Junior doctors in their thousands have made it quite clear what they think of the government’s plans to impose contracts in which junior doctors have no confidence.

“Today’s action – one that the BMA has long sought to avoid – is a result of a fundamental breakdown in trust with junior doctors, for which the government is directly responsible. This has only been made worse by yesterday’s last minute, inept and heavy-handed attempts to bully junior doctors lawfully taking industrial action back into work.

We deeply regret the level of disruption caused, but this is a fight for the long-term safety of patients and junior doctors’ working lives. The biggest threat to patient care is the government’s insistence on removing safeguards which prevent junior doctors from being forced to work dangerously long hours without breaks, with patients facing the prospect of being treated by exhausted doctors.

Junior doctors on strike at St Thomas’ hospital, London
Junior doctors on strike at St Thomas’ hospital, London. Photograph: Martin Godwin for the Guardian

Updated

Andy, a junior doctor who had been at Tooting Broadway tube station in south-west London earlier, said there was a bone marrow registration post there today, giving striking doctors a chance to do things they don’t usually get to do, such as signing up as donors. He said:

As well as standing outside picket lines we want to make a positive impact today and do things we don’t usually get to, like getting doctors to join the bone marrow register and potentially save treatment.

These are measure we’ve been forced to take. The contract is not safe.

Andy, a junior doctor outside St George’s hospital in Tooting
Andy, a junior doctor outside St George’s hospital in Tooting Photograph: Aisha Gani for the Guardian

Updated

Junior doctors on strike at St Thomas’ hospital, London
Junior doctors on strike at St Thomas’ hospital, London. Photograph: Martin Godwin for the Guardian

Updated

A junior doctor working for Sandwell and West Birmingham Hospitals NHS Trust, where strikers were told to go back to work because of high demand, has questioned why the situation has been labelled as an emergency. The medic, who wished to remain anonymous, told the Guardian:

We received the letter emailed to us this morning, but it was dated yesterday and it said the situation had been ongoing for some days.

We were not called in at the weekends to provide extra cover to discharge patients so why are we getting called in now? People called the BMA after they got the letters and we were told not to go back in.

This kind of situation happens all the time, especially in winter, over the whole NHS. You’d expect it to happen several times a year, it’s not at all unusual. I would imagine it’s the same situation with hospitals across the country, it happens very frequently.

So it’s odd that this has happened to junior doctors on the day of the strike, when the issue of discharges has been going on for a few days.

Updated

Another striker in Manchester has explained why he is striking, claiming the morale of junior doctors is being destroyed.

The shadow chancellor has shown his support for the strikers.

The picket line remains at Sandwell hospital where these junior doctors, in line with the BMA’s advice, continue to defy bosses who at 8.15am ordered them to return to work, citing high demand.

Updated

Since the dispute began in mid-September there has been a lot of confusion about who exactly counts as a junior doctor. Quite a few people have assumed the term refers to only young trainee doctors, fresh out of medical school, or those in the very early stages of training after graduation that – after about 15 years – usually results in doctors at last becoming senior doctors, ie consultants.

Some newspapers certainly gave that impression, at least early on in this now long-running contract row. It’s an easy mistake to make, especially when so many of the junior doctors who have given interviews to broadcast media have looked to be in their early 20s. However, actually far, far more doctors than that are classed, arguably unhelpfully, as “junior” doctors.

So, to (try and) be clear: in the NHS, a junior doctor is any level or grade of doctor below a consultant. So any medic who is a foundation year 1 or 2 doctor, or house officer or senior house officer, or registrar or senior registrar – the last stop before consultant status – is a junior doctor, even if they are in their mid or even late 30s. Or, sometimes, in their 40s.

There are about 45,000 of them across the NHS in England, of whom 38,000 belong to the BMA, and it was 98% of them who voted in November to strike in protest at the proposed new contract.

It’s easy for anyone not in the NHS or au fait with how medicine works to assume that junior doctors are all fairly young. To add to that confusion, all junior doctors are – technically at least – trainee doctors until they become a consultant, even if they are highly skilled and potentially in charge of busy wards full of medically needy patients, for example, as quite a few often are. A few readers have taken issue with me for referring in stories to junior doctors being “trainee doctors”, which was my way of avoiding undue and potentially tedious repetition of the phrase “junior doctors”. In my view medicine’s crude distinction between junior and senior (consultant) doctors, shored up by a series of acronyms that denote (to insiders) how far a particular junior doctor has reached in their training, is outmoded, open to (clearly) misinterpretation and also patronising and wildly hierarchical. Surely someone can come up with a better way of telling the world how experienced (or not) a doctor is?

But technically I am right to refer to them all as trainees, though I recognise how imperfect that is. The phrase I’ve used in many of my stories about the dispute over recent months, to try and convey the range of doctors covered by the term junior doctor, is “all doctors below the level of consultant”. That’s who they are, all 45,000 of them.

Updated

Striking junior doctors outside St George’s hospital in Tooting, south-west London, have a smiling poo depicting the health secretary, Jeremy Hunt.

The green posters that the striking doctors, some wearing their scrubs, are holding read: “We are one profession. We stand together.”

Some doctors said they had never done anything like this before.

Unlike a previous strike by nurses at the hospital, there was little singing or chanting outside the gates. No megaphone. It was an austere strike by doctors – some of whom have worked in the profession for many years – who feel the health service is coming under severe pressure.

Holding aloft a smiling poo emoji that was meant to be a visual representation of Hunt, Emily, a junior doctor wearing a stethoscope around her neck, said:

We get a lot of rubbish thrown at us.

We’re intelligent people and now is the time to stand together. We believe we deserve to be treated better and support our colleagues as well.

Some colleagues wished them good luck, others brought out cups of tea for the striking doctors of the hospital, which has about 1,000 hospital beds and is known for providing regional and national specialist care in cardiac, neurosurgery and cancer services.

Emily, junior doctor, outside St George’s hospital in south-west London
Emily, junior doctor, outside St George’s hospital in Tooting, south-west London Photograph: Aisha Gani for the Guardian

Updated

Justin Madders, a member of Labour’s shadow health team, writes in the New Statesman today:

Speak to any junior doctor and they’ll tell you the last thing they want to be doing is withdrawing their labour, but the truth is they feel like Jeremy Hunt has backed them into a corner and left them with no other way to get their message across.

There remains significant concerns with the proposed new contract that the government is trying to impose on junior doctors – not least the impact on patient safety as a result of junior doctors being forced to work excessively long hours – but today’s industrial action has become about so much more.

Junior doctors tell me they feel like they are the first line of defence for the future of the NHS. They feel like if they don’t stand up to the government now, then next it’ll be the nurses, the midwives and the healthcare assistants. Whether that assessment is right or wrong, it is a remarkable situation for junior doctors to find themselves in. Trust has been damaged, let us hope it is not irreversible.

Updated

Here is another interview from Laurence Topham, this time from outside the Royal London hospital in Whitechapel.

Ariane Waran tells him:

The one thing Jeremy Hunt has done is bring us all together...

Ariane Waran, junior doctor, outside the Royal London hospital in Whitechapel

Updated

Bridget Riley, who works in the gastroenterology unit at Sandwell, told Sky News that the recall, issued by the hospital at 8.15am on Tuesday, appeared to be pre-planned. She said:

They should only really call the strike off if it’s unpredictable. This is clearly predictable in that they knew about it yesterday so why did they not tell us about it yesterday?

Updated

With a stethoscope around his neck, Richard Sykes, a senior house officer in elderly care at St George’s hospital, in south-west London, said Jeremy Hunt had approached the negotiations “with a sledgehammer”.

The reason that we’re striking is we feel the government is trying to impose an unsafe contract on junior doctors which massively squeezes [the NHS] and doctors who feel undervalued and abused by the system.

Jeremy Hunt wants to unilaterally impose a contract which will further stretch tired and overworked junior doctors in a time of austerity.

If Jeremy Hunt had come to us and said: ‘Your elderly patients don’t all get seen in the weekend and we want to change that,’ that’s a serious rational concern that we could have addressed.

But he’s using rubbish statistics to push his own political agenda.

I think stretching what is currently a five-day cover without any more doctors or support services would reduce continuity of care and efficiency.

He said Hunt was using “intellectually immoral” arguments to suggest there was not a seven-day NHS, and calling for the same services on weekends as weekdays without providing the infrastructure.

As Sykes handed a passerby a leaflet he said: “Sorry we’re not at work today.”

Junior doctor Richard Sykes
Junior doctor Richard Sykes. Photograph: Aisha Gani for the Guardian

Updated

NHS England has released a statement in relation to what is happening in Sandwell, where the hospital trust has told junior doctors to go to work but the BMA has advised them not to until proper protocol is followed.

Anne Rainsberry, the national incident director for NHS England, said:

Sandwell hospital has reported that it has been experiencing exceptional and sustained pressure.

In line with the local agreement between the trust and the BMA, their medical director has asked junior doctors to return until such a time as the pressure is relieved.

The local NHS is actively reviewing the situation to support the trust. Nationally, we are continuing to work closely with our BMA colleagues to ensure patient safety.

Updated

Here is the full letter sent to doctors at Sandwell hospital in the West Midlands, who have been told to come in to work today.

Updated

Despite some junior doctors at Sandwell hospital being told to return to work because of high demand, there remains a picket line there.

In these videos, the BMA spokeswoman Helen Ratley says the agreement was that junior doctors would go back if there was a level 4 incident and it was escalated with NHS England and the BMA. She adds that despite declaring a level 4 incident because of high demand, the hospital has not followed correct protocol and so junior doctors will not return to work.

Updated

Dr Rebecca Wilson, who works in Stockport, says she feels “sick” at the changes to the contract being imposed and her colleague, Dr Helen Rielly, says she is being driven to the point of quitting.

Handing out stickers to passersby in the bitter cold outside St George’s hospital in Tooting, south-west London, GP trainee Miranda Lewis, who has been at the hospital for 18 months, said:

I think it’s really sad that it’s come to this but unfortunately we have to take this extreme action after negotiations broke down. It’s all about patient safety. And for juniors coming through we have to protect the NHS.

Today my ward has four consultants. So more doctors with experience so I have no doubt patients will be looked after. We’re sorry patients have had routine checks and operations rescheduled.

Most of these people coming in are staff. Some came in before 8am to do checks. We’re feeling slightly undervalued and work above and beyond the care of duty. The smear campaign by government and in the media makes us feel so undervalued.

As staff passed around cups of coffee to keep doctors warm, cardiothoracic registrar James Barr told the Guardian:

The infrastructure is not there, the beds are not there. We run a seven-day service. I think the issue is in our service we struggle to run a five-day service.

We run electives Monday to Friday. The idea of rolling out elective and clinical every day, it will be difficult and affect training of staff. And there will be less continuity of care. The research isn’t there.

At the moment it is being run on a shoestring. Compared to France and Germany the proportion of GDP spent on healthcare is much lower.

Also it will be hard to attract students when we will leave with a huge student debt of £80k and starting salary of £22k.

James Barr and Miranda Lewis, junior doctors striking outside St George’s hospital, in Tooting, London
James Barr and Miranda Lewis, junior doctors striking outside St George’s hospital, in Tooting, London Photograph: Aisha Gani for the Guardian

Updated

Caroline Lucas, the Green party MP for Brighton Pavilion, joined junior doctors on the picket line at St Thomas’ hospital in Westminster this morning.

Lucas said:

The junior doctors have reluctantly taken this action because the government simply isn’t listening. Their message to Jeremy Hunt is that he must get back around the table and stop trying to impose a contract that is both unfair for doctors and, crucially, potentially unsafe for patients.

This contract change is just one strand of the government’s attack on our NHS. Student nurses have had their grants snatched away – and costly NHS marketisation is continuing. Now junior doctors are making a stand against the bully boys in the Cabinet.

There is huge public support for these doctors on strike – I very much hope the government is listening.

Updated

Adam Slack, a junior doctor and anaesthesiologist, told Kylie Noble why junior doctors at Manchester Royal Infirmary are striking today:

A lot of us are just fed up with constant worsening of our pay, our conditions. There was the changes to our pensions, the continued pay freeze across the entire public sector. We’ve found it to be the last straw. It endangers patients as we will be working much longer hours. Also it endangers our quality of life, if they aren’t going to pay us any extra to come in on Saturday and Sundays when we’re already working full shifts, nights, weekends anyway and it’s making us work harder and harder for less and less money.

Updated

If you are striking today or have been affected in some other way, GuardianWitness has set up a callout for readers to contribute. Either follow the link or click the blue “contribute” button to share your photos, videos or stories.

Josh Halliday has been speaking to more strikers in Stockport on why they have joined the industrial action.

Some of the striking doctors have taken inspiration from David Bowie:

Updated

BMA says Sandwell doctors shouldn't go back

The BMA has advised its junior doctors not to respond to the request by Sandwell hospital for some of them to return to work because of high demand.

The hospital said: “We decided to require trainee doctors allocated to ward work to attend Sandwell during today’s strike.”

A BMA spokesman said:

Junior doctors should continue with industrial action until NHS England has confirmed and the BMA has agreed – via the agreed escalation process – that a major unpredictable incident is taking place for a specific Trust. The BMA will notify members as soon as such an incident is in place.

It also referred strikers to its legal advice on the issue.

Updated

Laurence Topham has visited the picket line at St Thomas’ hospital in Westminster.

Sarah Tyler told him: “We feel angry and very sad.”

Sarah Tyler, striking junior doctor, outside St Thomas’

Jeeves Wijesuriya, said: “We didn’t want this.”

Jeeves Wijesuriya, striking junior doctor, outside St Thomas’

...and a woman made sure they had some sustenance to keep them going

A woman gives out pastries to striking junior doctors outside St Thomas’

Updated

Prianka Padmanathan, 26, had tears in her eyes as she explained why she was on the picket line outside Bristol Royal infirmary rather than at work.

It feels horrible but I don’t think we have any choice. The new contract doesn’t have in place the safeguards to stop us working dangerous and excessive hours. I feel that it’s unsafe for the patients.

The government is selling it as creating a seven-day NHS. The problem is they are not prepared to provide any extra resources – no extra doctors or nurses, porters or anyone else. I don’t think it’s possible to improve services this way.

Padmanathan is a foundation year-two doctor undertaking research at Bristol University and working in the medical admissions unit at the BRI. She said most of her contemporaries would not be working in the UK in the next few years but heading abroad.

There’s already a huge recruitment crisis among doctors. Under this new contract it will become almost impossible. Out of my year group there’s about 40 of us. I know about five who have applied for a job in the UK. The majority are planning on travelling abroad. They are so worried about the situation. Hopefully we may persuade some of them to come back. I know the majority out in New Zealand and Australia won’t come back.

Sarah Ibitoye, 29, an acute medicine registrar at the BRI, said:

We feel we’ve come to the end of the road. Even though it’s not what we want to do, we feel we have no other choice. It doesn’t feel very nice being on strike. It’s the first time I’ve ever done anything like this. Like all my colleagues I do this job because I love it. I like trying to help people; the idea of being out here not doing my usual job is not a nice feeling.

At the moment the hours I work are tough but they are OK. There are already shortages. I work in the respiratory department. That has taken its toll. We do often stay after our rota hours to get the work done. My fear is that if a lot of people who are threatening to leave the country do so, next year will be even worse. There will be far more shortages, the chances of staying late will increase. At least now we know if we stay late those hours are monitored. The trust investigates why we go over our monitored hours and try to make changes. If that monitoring is gone, the ability to recognise a problem and make a change will be gone. That is frightening really. I know when I’m tired I’m not as effective in my job. I don’t want to put myself in that position where I feel I’m doing extra hours all the time and it changes the way I work.

Luke Carter, 27, a core medical trainee, said:

I’m against the government’s ideological push towards privatisation. If they get this contract for junior doctors through, the consultants will be next. If there’s a new consultant contract, that will be the end of the NHS as we know it. We’re lucky as doctors – we have a voice, we can fend for ourselves. But there’s a lot of people in society who don’t have that voice – who are being trampled on by the government. We do a difficult job. We get paid well. But I think the government should be honest if it wants us to work longer hours. If that’s what they want, they should say that.

Elsewhere in the city there were pickets outside Bristol’s famous children’s hospital, the maternity unit St Michael’s and the eye hospital.

Lin Clark, a retired public services worker, arrived with (slightly burnt) mince pies. “I was in hospital with my mother recently and I see how hard the junior doctors work,” she said. “I’m 100% behind them. This new contract is all about the government privatising the NHS.”

Updated

Raymond Tallis, the former professor of geriatric medicine at the University of Manchester and a consultant physician, said he had been “radicalised by the brutal assault on the NHS” by the Tories.

“I’ve not marched since I was a student but I was radicalised as a result of Andrew Lansley’s Health & Social Care Act - it’s a direct assault on the principles of the NHS,” he said on the picket line with junior doctors from Stepping Hill hospital in Stockport.

He added:

The greatest threat to patient safety is cuts in funding, putting things out to market. The private sectors picks things up and puts them down. The Tories’ plans are a frontal assault on the values of the NHS - it’s a war of values against prices.

Raymond Tallis, supporting striking junior doctors in Stockport, Greater Manchester
Raymond Tallis, supporting striking junior doctors in Stockport, Greater Manchester Photograph: Josh Halliday/Guardian

Updated

Pickets are also out in force at Manchester Royal Infirmary.

My colleague Josh Halliday has been visting the picket line at Stepping Hill hospital, in Stockport.

Midlands hospital orders striking doctors in

Sandwell hospital in the West Midlands says it has ordered some of its junior doctors to come to work because of high demand.

Dr Roger Stedman, medical director at Sandwell and West Birmingham hospitals NHS trust, said:

Over the last two days we have had very high numbers of patients come to hospital, and fewer than usual discharged.

Because of that we decided to require trainee doctors allocated to ward work to attend Sandwell during today’s strike. Staff taking action at City are unaffected. We would like to thank local doctors’ representatives for their constructive support and advice.


Updated

Andy Beamish, surgical registrar based in Sweden is back in the UK to support strike action. He splits his time at the royal college of surgeons and a hospital in Gothenburg.

Holding leaflets that read “we are one profession we stand together” and dressed in his scrubs, Beamish said:

I’m here because I believe so strongly what the Department of Health, Jeremy Hunt and the government is doing is so detrimental to patient care and the NHS as an institution and also as a sideline to us and working patterns.

It will be so damaging to those things that not causing a minor disruption today would be immoral and letting things go the way they are.

After a few years in surgery, and I know from many years of experience, sometimes an operation can kill someone. You need to make decisions knowing you’re capable and not exhausted working 13 hour shifts.

It’s dangerous not just to my patients and the NHS, but to us. Driving home late after a shift and our concentration levels is compared [as dangerous as] to drink driving.

Junior doctor Andy Beamish
Junior doctor Andy Beamish Photograph: Aisha Gani for the Guardian

My colleague, Steven Morris, has been interviewing doctors on the picket line in Bristol.

At St Thomas’s hospital in central London the 20-odd junior doctors on the picket line have been joined by members of the Lambeth branch of the Keep Our NHS Public campaign group, several people from the National Gallery Former Strikers group and a few members of the PCS union.

The hospital’s location, opposite the Palace of Westminster, means there are also a few journalists including Robert Peston, now of ITV, and his crew. The mood is upbeat as a few motorists crossing Westminster Bridge toot their support. One British Medical Association steward helps picketers – most of them in their scrubs with stethoscopes around their necks – forget the cold by handing round a box of croissants and Jaffa Cakes.

A delegation of senior Green party figures, including Caroline Lucas MP and leader Natalie Bennett, got a warm reception from junior doctors glad of some political support.

In his thick winter coat, gloves and BMA armband, Dr William Turner, a 31-year-old trainee anaesthetist, is one of the junior doctors on strike.

His main worry, he says, is that the proposed new contract will result in a 30% pay cut and remove safeguards that currently prevent juniors being forced by their hospital to work dangerously long hours.

That will lead to doctors potentially working 80 to 90 hours a week. That will result in tired doctors on the wards and we know that tired doctors make mistakes, so ultimately it’s putting patients’ lives at risk.

Turner’s normal working day involves learning his trade during operations of all sorts, from a hernia repair to a bowel resection, lasting between four and 10 hours.

The best kind of strike is one where you don’t have to deliver [actually walk out]. We are all here today with a heavy heart. No junior doctor goes on strike lightly. It takes an awful lot to push junior doctors into the position where they are ready to stand on the picket line and not treat patients. But that’s the position we are in because we have been pushed into it by the government.

Updated

Here’s the health secretary being put on the spot by the BBC’s Norman Smith this morning. He has refused to give interviews today and answered just two questions from Smith: he denied he was putting the NHS at risk and insisted there was enough money for the “seven-day service” he has been championing (although many doctors insist there is already a seven-day service).

Updated

A doctor supports the strike near University College hospital in London.
A doctor supports the strike near University College hospital in London. Photograph: Matthew Chattle/Rex/Shutterstock

The Royal College of Midwives (RCM) has expressed its support for today’s industrial action.

Jon Skewes, director of policy, employment relations and communications at the RCM, said:

We stand shoulder to shoulder with our NHS colleagues on this issue, and the Royal College of Midwives offers its support to the junior doctors. Like midwives who took strike action over the past year I know that patient safety will be the number one priority for the junior doctors, and that steps will be taken to ensure that those who need care will receive it.

These hard working health professionals are facing attacks on their pay, including on payment for working unsocial hours. This is also an issue facing midwives and other health professionals in the NHS, who are facing being paid less for working in the evening, weekends and at night.

Christmas chart-toppers, the NHS choir, have lent their support to the strike:

Sophie Herbert, a junior doctor at St George’s hospital in Tooting, south London, said:

I’m here because the government had failed to offer meaningful negotiations about a contract that is unsafe.

They are making the working conditions for doctors and nurses so difficult that there’s an exodus of these highly trained individuals to other countries and careers. We’re already contending with overwhelming staff shortages and we are already at breaking point, we can’t do any more. That is why we’re here.

We’ve been here since 8am and we’ll be here until 12pm.

My colleagues are at Tooting Broadway and will be going locally along the Northern line to talk to members of the public.

When asked about how she thinks the public perceives the strike action, Sophie said:

I feel supported by the public generally and hope they understand the reasons why we are striking. It’s the future of the NHS and it’s sad that it’s come to this.

Striking junior doctors at St George’s hospital in Tooting
Striking junior doctors at St George’s hospital in Tooting. Photograph: Aisha Gani for the Guardian

Updated

The Labour leader, Jeremy Corbyn, urged ministers to apologise for the failure to avert a strike. In a post on Facebook he wrote:

No NHS worker takes lightly the decision to strike, but the blame must be laid at the door of this government for the way it has treated doctors and now seeks to smear them in the press. It is time for this government to apologise to junior doctors and negotiate a fair deal that gets our NHS working again.

Campaigners dressed as junior doctors set up a fake betting shop storefront outside parliament.
Campaigners dressed as junior doctors set up a fake betting shop storefront outside parliament. Photograph: David Parry/PA

Junior doctors on the picket line outside Maidstone hospital in Kent.
Junior doctors on the picket line outside Maidstone hospital in Kent. Photograph: Gareth Fuller/PA

In this video from the Guardian’s healthcare network, junior doctors explain their concerns about the new contracts and why they’re taking action.

Junior doctors on why they’re striking

Updated

My colleague, Steven Morris, is in Bristol and has posted pictures from two of the hospitals there.

Updated

There are expected to be at least 100 picket lines today, according to the GMB.

Sky News is showing pictures of a picket outside Bristol Royal Infirmary. People are holding placards saying: “Junior doctors contract, its’s everyone’s fight.” There is also a large “Bristol Labour banner” on display (nationally Labour has expressed sympathy for the strikers, without throwing its support 100% behind the industrial action).

Updated

The strike has officially begun.

Updated

Today’s strike isn’t just affecting acute hospital trusts. Mental health services are being disrupted too.

Barnet, Enfield and Haringey Mental Health NHS Trust, in north-east London, expected three-quarters of its 65 junior doctors to be on strike today. “We are anticipating around 75% of the 65 juniors to take industrial action. A small number are choosing not to strike, including some vacant junior doctor posts which are filled by locus”, it said in a statement. It has cancelled some routine community and outpatient clinics “to minimise patient inconvenience”, though stresses that all essential services will be covered by appropriate staff.

In addition, “services for children and adolescents, working age adults and older people are all affected in some way by the industrial action. Planned outpatient appointments and domiciliary visits have been postponed and rearranged where possible, and consultants and specialty doctors are stepping in to support the safe provision of the service”, adds the trust, which treats 155,000 people a year at its more than 40 sites

Dr Jonathan Bindman, its medical director, said:

Thanks to the goodwill of our consultant colleagues we are able to cover a good number of the essential junior doctors’ roles. Of course, services like emergency assessments will be unaffected, and we will endeavour to provide as comprehensive a service as possible in the circumstances. In addition, we are ensuring that essential inpatient services will be covered by consultants, so care for our most vulnerable patients will not be affected.

It is a similar picture across the capital at the South London and the Maudsley NHS Foundation Trust, the NHS’s largest mental health trust:

During the industrial action, the trust is planning to deliver a reduced service that will cover emergency services only (similar to Christmas Day cover). This will include emergency admissions, place of safety suites, and psychiatric liaison support in our partner trusts’ accident and emergency departments through on‐call arrangements. Across the trust, this may mean that some routine clinics and community services could be cancelled.

Whilst we will not be running a full service, consultants will be working with nursing staff and other health professionals to ensure that patient care is not compromised. The trust employs 225 junior doctors and we recognise the right of these staff to take part in industrial action following the recent BMA ballot”, the trust said in a statement.

Dagan Lonsdale, 32, a specialist registrar in intensive care medicine, based at St George’s hospital in south London, explained to the Guardian why he is striking and what he will be doing today:

Doctors do not have a mass media machine. We do not have the powers of spin at the disposal of the Department of Health. What we do have is years of training in the evaluation of evidence and communication with people. Today, I will use these skills in a new way.

I will be outside my local tube station taking part in a nationwide campaign called Meet the Doctors. I will offer, to anyone who wishes to listen, to explain all of the issues that have led us to this situation.

No spin, just facts. I will explain how the removal of safeguards on doctors’ working hours will put patients at risk, how we already have a seven-day NHS, how I already work weekends and nights, and that the new contract will not change this. I will explain that doctors are working at the very limit of what is possible and that a move to stretch them further is dangerous.

I will say that we have tried to explain all of this to the government, that we tried negotiating and they did not listen, that 20,000 of us marched in the streets of London and they did not listen, that 98% of us voted for the strike because this contract is so unsafe and unfair, and still they will not listen. I will explain we are left with no choice but to take industrial action.

Dagan Lonsdale, junior doctor
Dagan Lonsdale, junior doctor Photograph: from Dagan Lonsdale


Professor Sir Bruce Keogh, the NHS medical director, has told hospitals to order doctors back to work if services become dangerously overstretched. In a letter to the directors of NHS, published by the Telegraph, he said doctors should be told to return if there is an “exceptional and sustained deterioration in performance”.

The BMA said Keogh was meddling with their right to strike.

Sir Robert Francis QC, who led the inquiry into the Mid Staffordshire scandal and is a non-executive director of the Care Quality Commission, said industrial action would only compromise patient safety.

Speaking on BBC Radio 4’s Today programme, he said:

The only way that matters can be solved for doctors and patients is for talks to continue and for emergency care not to be withdrawn.

Professor Sir Bruce Keogh, medical director of NHS England
Professor Sir Bruce Keogh, medical director of NHS England Photograph: Joe Giddens/PA

Updated

While Labour and the Liberal Democrats are sympathetic towards the junior doctors, they are not 100% behind them. Two parties have no such equivocation, though. They are the Green party and, unsurprisingly, the National Health Action party (NHAP), the small party dedicated to saving the NHS that fielded some candidates at last May’s general election.

Caroline Lucas, the Greens’ only MP, and other leading party figures will show their support for the striking doctors today by joining the picket line at St Thomas’s hospital in central London, directly opposite the Palace of Westminster.

The Brighton Pavilion MP sees today’s strike as “healthcare professionals standing up to the bully boys around the cabinet table”. She said: “We fully support the action being taken by junior doctors today. This strike is happening because the government is failing to address very serious concerns around safe working conditions, while failing to offer proper recognition for those working unsocial hours.” Lucas added:

Ministers have treated junior doctors with contempt and subjected them to a campaign of misinformation. It’s no wonder they’re at the end of their tether. This contract change is part of a wider government assault on our health service.

She will be joined outside St Thomas’s by Natalie Bennett, the Green party leader; Baroness Jenny Jones, a London Assembly member and Sian Berry, the party’s candidate to become Mayor of London.

NHAP co-leader Dr Clive Peedell, an NHS oncologist, says the strike is “a referendum on the government’s stewardship of the NHS”.

In his view:

Junior doctors have been left with no choice but to take industrial action. The government has not compromised on its agenda to force junior doctors into working more hours for less pay, so that it can drive through its ‘enhanced seven-day services’ manifesto pledge which makes no sense in the context of a £22bn NHS efficiency savings programme.

Peedell, who will be on the picket line outside University College London hospital today, added:

Despite the rhetoric from the Department of Health and NHS Employers, this remains an unfair and unsafe contract. Any potential inconvenience caused to patients by industrial action will be minor in comparison to the catastrophic long term risks to patient care resulting from an exodus of NHS juniors doctors if this contract is imposed.

Updated

At 8am, today junior doctors begin the first in a series of three strikes over planned changes to their contract – the first walkout by junior doctors in 40 years. The dispute between the British Medical Association, which represents 38,000 of the 45,000 junior doctors in England, and the health secretary, Jeremy Hunt, has become increasingly embittered and this time, unlike when a previous walkout was planned for 1 December, there has been no last-minute reprieve.

On Monday, NHS England said that 1,425 inpatient operations and procedures had been cancelled as a result of the strike alongside 2,535 outpatient ones. It said that 3,400 of the cancellations were today and 654 – 192 inpatients and 462 day cases – are in London.

The postponed operations amount to about 13% of the normal daily total of 30,000.

Across Greater Manchester, more than half (54%) of planned surgeries and “non-urgent day-cases” have been cancelled. Approximately 11% outpatient appointments have also been cancelled.

Emergency care is excluded from today’s industrial action but is likely to be affected nevertheless with NHS England saying hospitals would generally be under additional pressure.

There are believed to be about 100 pickets, at least, planned for outside hospitals.

We will be providing live updates from picket lines and on how the NHS is coping at a time when increased winter demand has already put a strain on services.

Updated

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