Thousands of resident doctors have begun a “damaging” five-day strike over pay after talks with the Government collapsed despite a plea from the Prime Minister.
Resident doctors were on picket lines across England from 7am on Friday in a move which is expected to disrupt patient care.
They are demanding a 29% pay rise that they say would restore salaries that have been eroded over the past decade.
Patients have been urged to come forward for NHS care during the walkout, and are still being asked to attend appointments unless told they are cancelled.
GP surgeries will open as usual and urgent care and A&E will continue to be available, alongside NHS 111, NHS England said.
Sir Keir Starmer made a last-minute appeal to resident doctors, saying the strikes would “cause real damage”.
“The route the BMA Resident Doctors Committee have chosen will mean everyone loses. My appeal to resident doctors is this: do not follow the BMA leadership down this damaging road. Our NHS and your patients need you,” he wrote in The Times.
It comes after Wes Streeting sent a personal letter to NHS resident doctors, saying: “I deeply regret the position we now find ourselves in.”
The Health Secretary said while he cannot pledge a bigger pay rise, he has been committed to progress to improve doctors’ working lives.
He added he does not now believe the British Medical Association’s resident doctors committee (RDC) has “engaged with me in good faith” over bids to avert the strike.
Striking doctors have told of difficult working conditions as they manned picket lines.
Resident doctor Kelly Johnson said Mr Streeting's opposition to the strikes felt like "a slap in the face".
Speaking outside St Thomas' Hospital in London, where she works, she said: "Every union has the right to strike. It feels like a slap in the face to say that we are doing something that is unjust.
"Just because we're doctors doesn't mean we can't come out and strike and protest for what we think is right.
"When doctors decide to take strike action it's always portrayed as though we're being selfish, but we're here as a body to help the public day in, day out, to work hours that don't even end sometimes.
"Here we are just trying to get what's right for us so we can do our best to serve the public."
Patients at St Thomas' Hospital voiced their support.
Jo Irwin, 72, who was attending the London hospital for a blood test before surgery for a hernia, said she had "no hesitation" in backing the walkout.
"I am fully behind the strikes and the public should be as well," she said.
"Without these doctors I would be dead. They are looking after sick people. I am very angry about it.”
Mohammed Dinee, 42, from Brixton, also gave his backing to the industrial action after being admitted recently with back pain.
"Today I had a physiotherapy appointment - it was fine, no complaints," he said. "But I got admitted other day for back pain - you could feel it. It was difficult to get an MRI scan.
"They're strained - being inside St Thomas', you can see it. I fully support them."
Mr Streeting said that based on talks with the BMA aimed at averting strikes, he had been determined to tackle the “arduous” training pathway, and “I made it clear that I was prepared to agree actions to reduce the costs you face as a result of training”.
He said he had also been looking at the cost of equipment, food and drink, and “was prepared to explore how many further training posts could be created – additional to the 1,000 already announced – as early as possible”.
Mr Streeting added that there is “no getting around the fact that these strikes will hit the progress we are making in turning the NHS around”.
Daniel Elkeles, chief executive of NHS Providers, said agency health staff will be working “flat out” to see as many patients as they can during the strike, after NHS England made clear it wants as much pre-planned care as possible to continue.
He said: “Striking doctors should think carefully if they are really doing the right thing for patients, for the NHS and for themselves…
“The strike will throttle hard-won progress to cut waiting lists, but NHS trust leaders and staff will be working flat out to see that as many patients as possible get the care they need.”
It is understood that NHS chief Sir Jim Mackey had told trust leaders to try to crack down on resident doctors’ ability to work locum shifts during the strike and earn money that way.
Leaders have also been encouraged to seek “derogations”, where resident doctors are required to work during the strikes, in more circumstances, the Health Service Journal (HSJ) reported.
Rory Deighton, acute and community care director at the NHS Confederation, said: “These strikes were not inevitable – the Government entered negotiations with the BMA in good faith…
“The impact of these strikes and the distress they will cause patients rests with the BMA.”
The BMA has argued that real-terms pay has fallen by around 20% since 2008, and is pushing for full “pay restoration”.
The union is took out national newspaper adverts on Friday, saying it wants to “lay bare the significant pay difference between a resident doctor and their non-medically qualified assistants”.
It said the adverts “make clear that while a newly qualified doctor’s assistant is taking home over £24 per hour, a newly qualified doctor with years of medical school experience is on just £18.62 per hour”.
RDC co-chairs Dr Melissa Ryan and Dr Ross Nieuwoudt said in a statement: “Pay erosion has now got to the point where a doctor’s assistant can be paid up to 30% more than a resident doctor.
“That’s going to strike most of the public that use the NHS as deeply unfair.
“Resident doctors are not worth less than they were 17 years ago, but unfortunately they’ve seen their pay erode by more than 21% in the last two decades.
“We’re asking for an extra £4 per hour to restore our pay. It’s a small price to pay for those who may hold your life in their hands.”
The Department of Health and Social Care (DHSC) said the framing of the BMA advertising campaign was “disingenuous”.
“Given their repeated use of debunked ways of measuring inflation to overstate their pay claims, it follows a pattern of deliberately misleading calculations from the BMA,” a spokesperson said.
“The average annual earnings per first year resident doctor last year was £43,275. That is significantly more, in a resident doctor’s first year, than the average full-time worker in this country earns.
“Resident doctors in their second year earned an average of £52,300 last year and at the top end of the scale, resident doctors in specialty training earned an average almost £75,000 – this is set to increase further with this year’s pay award.”
