Junior doctors in England are taking part in the second day of an all-out strike between 08:00 and 17:00 BST
Action affects emergency, maternity and intensive care for the first time in the long-running dispute
Health Secretary Jeremy Hunt describes it as "bleak day" for NHS
Junior doctors are angry at the government's imposition of a new contract
The new contract makes it cheaper to rota doctors on at weekends, as part of plans for a seven-day NHS
Image source, ReutersPlacards outside St Thomas' Hospital called for Health Secretary Jeremy Hunt to resign
Image source, ReutersThere were signs referring to Mr Hunt outside King's College Hospital in London too
Image source, AFP/GettyDoctors outside Basingstoke and North Hampshire Hospital said they were being stretched too far
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Figures released by NHS England showed 78% of junior doctors due in work today did not turn up.
The British Medical Association membership covers about 80% of junior doctors, although non-members can still strike.
In preparation for the stoppage, hospitals in England cancelled more than 100,000 routine appointments and nearly 13,000 non-emergency operations.
This allowed them to redeploy consultants, middle-grade doctors and nurses into emergency services, such as A&E, maternity and intensive care.
Martin Winch
BBC Coventry & Warwickshire
Pam Wynne (pictured) is one of those joining the picket line at Coventry's University Hospital.
She says it's a "tragic and sad day" for the NHS and describes it as the "worst day of my working career".
Quote MessageFragments of my profession will travel the world to get away from the system Jeremy Hunt is trying to introduce
Pam Wynne, Junior doctor, UHCW
Up to 300 people are in Victoria Square, Birmingham where junior doctors are holding a rally.
They are joined by members the NUT, NUJ, PCS, UNITE and members of Stop the War.
Ministers have said the first all-out doctors' strike in the NHS's history is a "bleak day.".
Image source, bbc
Nick Triggle
Health Correspondent
Hospitals seem to be coping well with the all-out strike by junior doctors.
A number have told the BBC services have run smoothly - with some saying they have even been quieter than normal.
It appears patients have heeded warnings to stay away unless it is an emergency.
And no trust has triggered the emergency escalation procedure which allows them to ask striking doctors to come back to work.
But there are fears the end of the strikes on Wednesday evening will see a surge in demand.
The Hospital Consultants and Specialists Association (HCSA) has called for fresh talks aimed at a deal being reached.
Professor Ross Welch, president of the senior hospital doctors' union, said:
Quote MessageConsultants and specialists will be stepping into the breach today to ensure that excellent patient care continues across our NHS for those most in need. Senior hospital doctors have for weeks been working with trusts to ensure that the most vital services, including cancer care, are provided. However, they do so with a sense of growing frustration with a government that refuses to lift the threat of planned imposition of the new contract for doctors in training."
Quote MessageThe HCSA has always backed in principle the idea of seven-day services, but not at any cost. There is no shortcut to a safe seven-day service, and widespread concerns over the impact of the current proposals on recruitment, retention and the health and well-being of the next generations of hospital consultants must not be ignored.
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Liam Walker, 35, the general manager of a pub in London, said his partner was currently in labour and that he supports the strike.
He told the BBC:
Quote MessageMy partner is currently in the labour ward of St Thomas's Hospital where there are no junior doctors. There are three consultants instead of three juniors. I completely agree with the walk out - I'm fed up with this government doing what they want with the public purse. I think Dennis Skinner MP is right. Mr Hunt is enjoying the fight with the BMA union and letting his personal feelings get in the way of doing the right thing. I have nothing against the junior doctors striking but we've had fantastic treatment from the consultants."
Press Association
David Cameron's official spokeswoman said the prime minister was being "kept updated on the situation" with the strike.
Asked whether the PM thought public support for the junior doctors was fading, the spokeswoman said people would be asking 'is this an appropriate and proportionate response to take?'.
She also said Jeremy Hunt had written to the head of the BMA, asking to meet to discuss "broader issues around working conditions for junior doctors because we would like to work with them on this and move forward".
The spokeswoman added:
Quote MessageWe've had three years of talks, there have been numerous concessions, we have done all we could to avoid these strikes. It has ultimately been a decision for the junior doctors to go ahead."
The World at One
BBC Radio 4
Sarah Wollaston said it would be "too complex" to stagger the introduction of the new contract by piloting it in some areas.
She said there had been a "huge amount of acrimony" and a "complete breakdown in trust".
But she said she thought Jeremy Hunt "genuinely tried to make the changes with good intentions to try to address the weekend effect as he saw it".
Ms Wollaston added if the BMA forced an indefinite all-out strike "the consequences would be catastrophic".
The World at One
BBC Radio 4
Sarah Wollaston said the BMA needed to acknowledge the dispute was about "far more than merely inconvenience for patients".
Ms Wollaston also said the government needed to look at NHS staffing and junior doctor concerns that having more doctors working on the weekend would leave staffing more stretched during the week.
She said both sides needed to acknowledge there was "far more to this than pay".
The World at One
BBC Radio 4
Sarah Wollaston, the Conservative MP and chairwoman of the cross-party health select committee, said it was a "desperately sad day".
The former GP said both sides had "dug their heels in" and the issue would not be resolved unless they got back to the negotiating table.
She said:
Quote MessageI think everyone is forgetting the patients in this. We're seeing a huge number of urgent procedures and outpatients and operations cancelled across the country today, and both sides need to focus on the people who really matter here, which is the patients.
BBC News Channel
The BBC's assistant political editor Norman Smith said Downing Street was playing down claims it saw the dispute as similar to the miners' strikes of Margaret Thatcher's government, which they had been "determined to win, however long it took and whatever the cost".
But he said the government did see the junior doctors' dispute as an "absolute must win" because it regarded it as a challenge to its political authority and political mandate to implement a manifesto commitment for a seven-day NHS.
Our correspondent said he understood Jeremy Hunt would renew his offer to the BMA to discuss "anything they want apart from the new contract".
He said this letter had been sent to what Downing Street believes is the "more moderate leadership" of the BMA - rather than the junior doctors committee.
He said the government hoped the leadership would put pressure on the junior doctors to "back down" and that there would not be a repeat of the mining strike.
Royal colleges from Scotland - which represent members across the UK - have written to Scotland's first minister to express their concerns over the junior doctors contract dispute in England and what they call the "ongoing and damaging uncertainty it is having on the NHS across the UK".
The colleges said Nicola Sturgeon had responded by today writing to David Cameron to ask him to lift the imposition of the junior doctors’ contract in England and enable negotiations to resume.
In a joint statement, the Royal College of Physicians of Edinburgh, the Royal College of Surgeons of Edinburgh, and the Royal College of Physicians and Surgeons of Glasgow said:
Quote MessageWe very much welcome the commitment from the Scottish government not to impose the junior contract in Scotland and welcome the first minister’s letter to the prime minister to ask him to remove the threat of imposition and return to negotiations. We believe that imposition in England will have far-reaching and unintended consequences for healthcare across all nations in the UK for the foreseeable future.
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Here doctors can be seen striking at the Royal Cornwall Hospital in Truro.
They are supported by Malcolm Lawrence, who worked for NHS for 40 years.
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Caroline Jones is a junior doctor at the Princess Royal Hospital in Telford.
As a single mum with two children, she says the new junior doctors contracts are a source of stress and she is considering changing career.
Currently junior doctors are paid more for working unsocial hours at night or at the weekend, but under the new contract, the Saturday day shift will be paid at a normal rate in return for a rise in basic pay. Strikes are under way in protest, but health secretary Jeremy Hunt says no union has the right to stop a government trying to act on a manifesto promise.
Ms Jones, who is currently working night shifts and therefore not taking part in the daytime strikes, has recorded an audio diary.
Hugh Pym
BBC News Health Editor
Nottingham University Hospitals Trust says essential services are being provided without any problems.
Senior nurse practitioners are working alongside consultants to fill gaps left by the strike.
Attendances at accident and emergency are lower than usual, with patients probably getting the message not to come unless they need urgent care - though that may store up demand for later in the week.