Junior doctors have returned to work this morning after their fourth walkout in a dispute over the new junior doctors' contract.

A deal between the government and the British Medical Association is no closer after the 48-hour action and government sources say the doctors' union has blown its chance to negotiate.

The next strike is on the 26 and 27 April, from 08:00 to 17:00, when junior doctors will walkout of A&E and intensive care. This has never happened before in the history of the NHS.  

There is a chance ministers could end up undermining their long-term strategy, says health correspondent Nick Triggle. 

As well as potential issues with morale and attitude, there is a risk this dispute could have a real impact on the numbers staying in the NHS in England, he writes. 

Read more.

Junior doctors have been posting pictures on Instagram of the industrial action today.

Instagram user offdutydoctor warned the NHS "is disappearing": 

Sandy Robertson said he was demonstrating against "the imposition of an unsafe, unfair, discriminatory #juniorcontract, external": 

Maevis Tan said she and her colleagues were "standing up for what we believe in": 

One Twitter user has said they now have to wait until next week to receive vital results.

We have seen plenty of photographs from the picket lines across England today - and now an artist has tweeted a picture she's drawn of the scene outside St Thomas' Hospital in central London. 

Comedian Shappi Khorsandi and Margaret Cabourn-Smith, who has starred in Miranda and Peep Show, were among those to attend a rally at Ealing Hospital in west London this lunchtime.

NHS trusts have reported today that 42.5% of junior doctors - out of a possible 26,000 working on a typical day - have turned up for duty on the day shift.

On Wednesday NHS England said 46% of junior doctors turned up for work at hospital.

The figures are broadly similar to previous walkouts earlier in the year - which stand at 39% and 44%.

Many doctors working will have been staffing emergency care services as agreed under the terms of the strike - there are about 17,000 junior doctors who are not British Medical Association members.

Junior doctor Jonathan Barnes says he is “tired and worn down from the government's constant barrage of attacks on me and my profession" and that the new contract "will see doctors working more while earning less under less regulated and less safe conditions". 

As a reminder, the DoH has issued the following advice to patients in England:

• If you have a planned operation, procedure or outpatient appointment on these days your hospital will contact you if it needs to be rearranged
• GP practices will be open and working as normal
• If your condition is serious or life-threatening call 999 or go to A&E
• If you need medical help but it’s not serious or life-threatening please contact your GP, visit your local pharmacist, call 111 or consult www.nhs.uk

The NHS choir has been performing - in the rain - outside Hackney Town Hall as part of a rally in support of the strike this afternoon. 

The British Medical Association (BMA) says that thousands of junior doctors have joined more than 140 picket lines across England. 

It notes that during the industrial action, they have organised blood drives and courses to teach life-saving skills to members of the public. 

Dr Johann Malawana, BMA junior doctor committee chair, said: 

He said that junior doctors "deeply regret any disruption caused to patients", and added:

Image source, Jason Seebaluk

Fears have been raised that junior doctors could leave their jobs in the UK for jobs overseas if the new contracts come into force. 

The BBC has been speaking to some of those who are considering their future.  

Dr Jason Seebaluk, 27, who works in Euston, London, is moving to Australia later this year.

Junior doctors on strike have been teaching CPR outside Stratford Station in London this morning. 

While others have been getting creative with pavement art, as this tweet shows.