As it happened: Doctors take action

Hello and welcome to our live page covering the industrial action being taken by doctors across the UK. The extent of disruption today is not yet clear. The NHS is advising patients who need help in an emergency to use the service as they normally would. We'll bring you all the news and analysis from the day as it unfolds.

Appointments for urgent tests, such as for cancer, are expected to go ahead as planned. Accident and emergency units will remain open, while mothers in labour will be able to go to maternity departments. But routine appointments and operations could be affected, the BMA has warned.

BBC correspondent Dominic Hughes is at Barnsley Hospital, where he says they've had to cancel or postpone eight operations out of 52. The hospital has also postponed around 20% of outpatient appointments. The medical director says the industrial action should have a fairly low impact on patients.

Dr Prit Bittar, a GP in his 50s and a former member of the BMA's General Practitioners Committee, tells BBC Radio Berkshire that he's striking "with great reluctance... we've been driven to this by a government which has refused to negotiate with us".

Doctor Paul Cundy, a GP who has a surgery in Wimbledon, told the Today programme earlier that he is taking industrial action "very reluctantly". He said he "understands that patients feel they are caught in the middle of this".

BBC health correspondent Nick Triggle says: "The scale of the disruption to patients will depend on just how militant doctors are. Ahead of the day of action, plenty of doctors said they would be supporting it but would not be turning patients away even for routine appointments. This has meant that some NHS trusts have cancelled only a very small proportion of bookings in advance."

Our correspondents across the UK will be aiming to help us build up a picture during the day of how much affect the industrial action has been having. BBC Radio Oxford is first off the mark with some figures outlining the situation around its region. In Oxfordshire itself, 29 GP practices are taking action, 49 are not and six did not reply.

In Buckinghamshire, nine are, 48 are not, in Wiltshire the split is 20/38 and in Swindon we've learned that 27 are taking action but have yet to get a definitive figure on how many are not.

Trevor Pickersgill, a consultant neurologist at the University Hospital of Wales in Cardiff, tells BBC News viewers that doctors are sorry for any inconvenience. "Patients are still our first priority," he says, but explains that this is the first time in nearly 40 years that doctors have felt this strongly about changes to their pay and conditions. There have been cancellations for elective surgery such as knee and hip replacements at the university hospital and Dr Pickersgill warns this could be the "first day" of further industrial action.

So do you understand what today's action is about? Doctors are angry that the government is changing their pension scheme just four years after a new deal was reached - but the government, in turn, insists it is not sustainable. The British Medical Association - the doctors' trade union - has argued that contributions are going up too much and that asking doctors to work until they are 68 is wrong and could harm patient care. Our Q&A explains the issues on both sides.

The last time doctors took industrial action was in the mid 1970s when consultants and junior doctors decided to withdraw non-emergency services, the BBC's Neil Bowdler writes. The consultants worked to rule and suspended all "goodwill activities" between January and April of 1975 in protest against proposed new contracts which they said would force them to abandon private practice.

Another snapshot on how one hospital is affected, this time the Royal Berkshire hospital in Reading.

It says that no operations have been cancelled, which means 71 due to take place there today will go ahead, as well as a further 61 surgical procedures in "satellite locations". It adds that 2,000 outpatient appointments are going ahead as normal but there are three clinics which are slightly affected with a handful of appointments cancelled.

The Trust says it employs just under 600 doctors, of which approximately 15 are taking industrial action.

On the BBC News channel, Health Secretary Andrew Lansley has suggested that the British Medical Association is isolated: "The BMA are out on their own.

"I hear them saying 'we want to go back to 2008' like nothing had happened since 2008. Like we're not facing up to a financial deficit and a need to reduce the deficit over the coming years and put the public finances on a sustainable basis."

Figures in from BBC Radio Northamptonshire: it has learned that 78% of GPs' surgeries in the county are expecting to offer a normal or near-normal service today.

BBC Radio Stoke has learned that Heartlands Hospital Birmingham rearranged 21 "elective appointments" and just over 200 outpatient appointments. So far two doctors at the hospital have informed management they will not be working today.

Some data from Queen Elizabeth Hospital, in Birmingham: 48 out of 650 doctors said they were planning to take strike action. This has led to the cancellation of three elective procedures - the hospital says it carries out an average of 100 operations or procedures per day. In addition, 15 day case surgery appointments have been cancelled (200 take place each day), and 38 outpatient appointments called off (2,000 is the number seen on a typical day).

All patients whose appointments have been rescheduled by hospitals in Wolverhampton have been notified and been offered alternative times, BBC Radio Stoke understands. Meanwhile, 231 out of 236 GP practices across Wolverhampton, Walsall, Dudley and Sandwell have confirmed that they will be open.

So after years of planning, you plan to open a new hospital on Midsummer's Day. What could possibly go wrong?

Despite the background of the industrial action taking place around the UK, bosses at the all-new South West Acute Hospital, near Enniskillen, have gone ahead with their grand opening this morning. It is already celebrating its first new arrival in the maternity unit - a baby boy for patient Lisa McGuinness.

Patients sympathise with their doctors, Dr Rob Barnett from Liverpool Local Medical Committee tells BBC Radio Merseyside. About half of all GP practices in Liverpool are taking some form of action today, but no GPs are away from work: they will see patients in need of urgent medical attention, Dr Barnett says. Nonetheless, his surgery is "uncannily quiet".

In Leicester, Leicestershire and Rutland, 24 out of the 148 GP practices are taking industrial action, BBC Radio Leicester learns.

Neither queues nor picket lines are in evidence at the Royal Liverpool University Hospital, where administrators say the impact is "minimal". One patient says her doctor even met her in reception and saw her early.

"It's not fair," Dr Laurence Buckman, the head of the GP committee from the BMA says on the BBC News channel. The NHS pensions scheme is already well funded, he says, accusing ministers of reneging on their predecessors' deal which was struck in 2008. "It's that frustration and the unfairness of having to pay more when there's already enough in the scheme," he says. "I've never taken industrial action; I never want to again."

Across Hampshire, Southampton and Portsmouth, 29 GP surgeries out of 225 are affected by industrial action today, according to the press office at NHS Portsmouth.

"A lot of our patients are being seen as normal," Barnsley Hospital director of human resources Hilary Brearley tells the BBC News channel. She calculates that 20% of outpatient appointments have been rearranged. Eight operations have been moved; some were brought forward. Less than half of the doctors at the hospital have chosen to take action, but their colleagues respect their right to protest, she says.

Wondering how services are being affected in Wales? BBC Wales has got a statement from each of the seven local health boards as part of its comprehensive coverage of the industrial action.

"Wowsers." That was how one BBC Scotland viewer responded when they stumbled upon a doctor's payslip that had been mislaid in a library. "If doctors aren't happy with their pay and pensions they should find another job," said another. These points were put to Maeve McPhillips, a paediatric radiologist in Edinburgh, on the BBC News channel. "I'm not sure that we've lost public support," she responded, adding that people would understand why doctors had decided to take action.

The BMA is guilty of "putting cash before care" today, part-time hospital doctor and Conservative MP Dan Poulter has said. The doctors' pension scheme is not sustainable, he told the BBC News channel, explaining why he resigned from the BMA. "If doctors want to receive a £68,000 pension, they've got to pay for it." Being a doctor is a "vocational calling; it's about putting patients first," he says.

Doctors' wages are modest in comparison to those of pop stars and footballers, says Christopher Ivans, a patient at University Hospital in Cardiff, whose appointment went ahead as planned today. He told the BBC News channel he supported the doctors "100%".

BBC health correspondent Jane Hughes says: "At the Temple Fortune group practice in North London, four of the five GPs who work there are on strike. There's a steady trickle of patients coming through the doors, but staff say it's much quieter than usual. Most routine appointments have been cancelled, but anyone who feels they need to see a doctor today is being treated.

"The doctors here all feel the same - that patients come first, and that taking industrial action goes against all their instincts. But for four of them, the feeling that the government was being unfair and unjust in imposing new pensions conditions was stronger. They felt they had to make a stand."

Jane Hughes has also been speaking to patients at the Temple Fortune practice and reports that their feelings are mixed. She says: "Some have seen their own pensions reduced and feel sympathy, but others say doctors hold positions of trust and should continue treating patients."

The changes to pensions are being "imposed", Lewis Morrison, a geriatrician in Edinburgh, argues on the BBC News channel. "Either the Scottish government or the UK government should negotiate with doctors," he says. "They claim they've negotiated this, but they haven't."

Getting a full picture of the number of operations cancelled and appointments postponed is difficult, writes the Guardian newspaper. "The Department of Health has asked NHS trusts not to reveal details to the media," it reports.

The BBC's Nick Triggle understands that the Department of Health is collating the figures from individual NHS trusts and expects to release official information about the extent of the disruption late this afternoon.

A sharp-eyed snapper from the Press Association spotted this rather neat juxtaposition of signs outside a health centre in Sheffield.

NHS Cumbria has announced that 47% of GP surgeries in the region have at least one doctor involved in industrial action, but they all remain open for urgent cases.

At North Cumbria University Hospitals Trust, 21 non-urgent operations and 79 outpatient appointments have been rescheduled; at University Hospitals of Morecambe Bay NHS Foundation Trust the figures are 65 and 290.

Scotland's Health Secretary Nicola Sturgeon says 60% of Scottish GP practises have been affected by today's industrial action by doctors. Ms Sturgeon told Holyrood that 3,200 outpatients appointments and 450 inpatient and day cases had been cancelled.

Maidstone Hospital has told BBC Radio 5live that disruption is minimal: no cancelled operations; five operations rescheduled; 12 appointments rescheduled.

Although the pensions issue is being depicted as doctors standing up against the government, it should be remembered that there are nine current MPs who are or have worked as doctors. Among them is Conservative Sarah Wollaston who writes in the Daily Express. "It is plain wrong for doctors, who receive among the most generous pensions in the public sector, to put self-interest before vocation. How will those in the minority who decide to put pensions before patients look them in the eye when they resume normal duties?"

Another of those doctor MPs is Dr Dan Poulter, who resigned from the BMA three weeks ago in protest at the planned strike action. Today he said: "The whole part of the doctor-patient relationship is built on trust and the idea that doctors are always acting in the best interests of their patients. What we're seeing today is the British Medical Association putting cash before care and that's unacceptable and I don't think patients are going to like that."

More on the dispute in Scotland: Health Secretary Nicola Sturgeon was a timely stand-in for Alex Salmond for First Minister's Questions in Holyrood and said she "deeply regretted" the decision by doctors to take action, specifically those who were doing so in Scotland.

She said: "They say the action is being taken to force the UK government back to the negotiating table. I should point out that the Scottish government has never left the negotiating table. I consider the action not just unfortunate but unnecessary as well."

Back in Holyrood, the Scottish Conservative leader Ruth Davidson was not impressed by Nicola Sturgeon's answer on today's dispute. She said: "I didn't hear anything from the Deputy First Minister about why £68,000 is an unfair pension outcome. I didn't hear anything about whether she would increase that at the expense of lower-paid public sector workers, just more SNP grandstanding that they would do something different, just don't ask what."

Dr Hamish Meldrum, chairman of the BMA, tells the BBC News channel that today's action should not be judged solely on the impact felt by patients - because it falls short of a full strike. "It has never surprised me that when it came to the crunch a lot of doctors do not want to take this out on patients," he said.

He pointed out that the BMA's aim was to maximise the publicity for its primary argument - that it is only four years since doctors agreed a new pensions deal with the government. "The government decided to walk away from that deal. We hope the public will see the unfairness of that," he said.

Health Secretary Andrew Lansley issues a statement after the release of the official NHS figures showing that 10% of patients have been affected. He says: "In the run-up to these strikes our objective has been to minimise disruption for patients. We asked doctors to recognise that their quarrel was not with patients but with the government. I am pleased that a significant majority of doctors have done just that and maintained services for their patients."

Andrew Lansley adds that the next priority must be to ensure that those NHS patients who did not get their planned treatment today have that situation rectified "as soon as possible".

On the situation at GP surgeries around England, the Department of Health says that three-quarters are operating a normal or near-normal service.

West of England correspondent Matthew Hill is reporting from outside the Frenchay Hospital in Bristol, where he says that behind the scenes managers have been working frantically to swap those doctors who are taking industrial action onto non-urgent work and vice versa, where possible.

The scale of disruption in London is becoming clearer. "More than 90% of all hospital doctors in London are working normally," NHS London says. 490 operations have been rescheduled, representing about "10% of the total number of operations anticipated on the day." 83% of all GP practices in London are working normally.

Remember that first birth we told you about at the newly-opened South West Acute Hospital, near Enniskillen (see 1031)? Well that baby now has a name. Shea Maguire entered the world weighing 8lb 8oz and blissfully unaware he was born on a day when doctors around the UK were taking industrial action (although maternity units were deliberately excluded from the action). If you want an opportunity to say "aaah", there's some video here.

Leicester Hospital's Phil Walmsley says: "The action by doctors today has had minimal impact on the normal running of our hospitals." 25 doctors out of 1,676 are taking action today, he says; 31 operations and 73 outpatients' appointments have been cancelled. To put that in perspective, the hospital says it usually carries out about 4,200 outpatient appointments and 420 non-urgent operations.

NHS Lincolnshire says that 21 out of 102 GP practices are providing a "modified" service, although they are still offering urgent and emergency cover. None of the surgeries in the area are closed due to industrial action.

NHS London has updated its previous estimates: it now believes that 520 operations have been rescheduled and 77% of all GP practices in London are working normally. Its earlier figures were 490 operations and 83% of GP practices.

The latest from Nottingham University Hospitals Trust: fewer than one in 10 doctors took action there today. Seven planned operations out of 140 were rearranged and around 80 out of "several thousand" patient appointments were rescheduled.

Sharply criticising the BMA, Health Secretary Andrew Lansley said that "thousands of patients who expected to have an operation or an appointment today have been inconvenienced or distressed by delay to their care". This was "extremely regrettable", he said, calling on the BMA to "co-operate" with further negotiations on the future of their pensions.

The industrial action will continue until midnight, and the mutual recriminations about whether the government or the BMA is to blame for the stalled pension negotiations are likely to last much longer, but we're concluding our live page coverage. We leave those of you wondering whether the BMA has achieved its goals with a statement from its chairman, Dr Hamish Meldrum: "Our intention was not to maximise impact on patients, but to communicate the scale of doctors' anger and to encourage the government back to the table."