Malu Cursino
Reporting from Trafalgar Square

The mood at Trafalgar Square is now completely different from when I arrived about an hour ago.

Junior doctors, media teams and members of the public are now in the square together with the sound of R&B and hip-hop in the background.

The message from junior doctors is clear - they say they want to be valued by their employer, the government.

Doctors at different stages of their careers want change. As one doctor Stephanie Wentzel tells me that they want it for the incoming doctors more than anything - as they’re starting on wages of £14 an hour amid a cost-of-living crisis.

I’ll keep bringing you the latest.

Simon Jones
In Ashford

There’s a small picket line outside the William Harvey Hospital - it's one of five hospital sites run by the East Kent Trust, one of the largest trusts in England.

Lots of people in passing cars are tooting their horns in support of the junior doctors.

The doctors tell me they do believe they have the backing of the majority of the public, but recognise some patients who’ve has their treatment cancelled will be feeling frustrated.

Hospital bosses insist this is not a dispute they can resolve - it’s a matter for the government and the BMA.

Image source, PA Media

Liberal Democrat leader Sir Ed Davey has been out in Woking, Surrey, today - and has repeated his party's demand for Parliament to be recalled over the ongoing junior doctors' strike.

"Everyone wants to see an end to the doctors' strike but the government have failed to get round the table," he said.

"It took them months to get round the table with the nurses. Eventually a resolution was found but they failed with the junior doctors.

"That's why we need to hold the Conservative government to account and Parliament must be recalled.

Shadow chancellor Rachel Reeves has accused the Conservatives of running the NHS "into the ground", claiming public services have got worse under Tory governments.

Earlier, Shadow health secretary Wes Streeting tweeted, external to say it was "astonishing" that no government health minister appeared on BBC Radio 4's Today programme to "explain their abysmal failure to avert junior doctors’ strikes".

Sir Keir Starmer has previously urged the government to negotiate to resolve the strikes. The Labour leader has previously faced criticism from some quarters for telling his MPs not to join picket lines - saying the single most effective thing the party can do is win power.

Malu Cursino
Reporting from Trafalgar Square

I've just been speaking to the co-chair of the BMA’s junior doctors committee, Vivek Trivedi - who's called on the health secretary to come to the table and negotiate pay.

Trivedi says pay is a direct reflection of how valued the junior doctor workforce is - and as a result of doctors' pay in the UK, many are leaving for countries like Australia.

Asked whether their request was unreasonable - a view expressed by Health Secretary Steve Barclay - he points out that there are roughly 9,000 doctor vacancies in the NHS, and more than seven million patients on the hospital waiting list.

“Is it reasonable to inflict a more than 26% real terms pay cut onto your workforce and expect them to do nothing about it?" he asks.

“All we want to do is reverse that. We’re happy to negotiate on how we get that, but we need Mr Barclay to come to the table”.

Malu Cursino
Reporting from Trafalgar Square

Hello from Trafalgar Square in central London, where I'm expecting to hear speeches as the British Medical Association (BMA) medical union rallies for better pay and working conditions for junior doctors.

For now, the square is made up of BMA members wearing their hi-vis jackets, a small police presence and many tourists and families enjoying the day.

As well as being a popular tourist destination, Trafalgar Square is just up the road from Whitehall where key government decisions about junior doctors’ pay are made.

I’ll be bringing you the latest from the ground.

Gem O'Reilly
Live reporter

We've been hearing from junior doctors striking across the UK today, with many sending photos of where they are and describing the atmosphere around them.

Dr James Collins, an anaesthetic registrar in south-east England, said: "Morale feels good here. We have sandwiches and snacks from members of the public and have some music playing.

"But we are frustrated that we have had to come out again and urge [Health Secretary] Mr Barclay to come to the negotiating table".

Image source, James Collins

Ed, a junior doctor training in the Midlands, said: "We have been trying to talk and negotiate with the government for months, and they have ignored us.

Unfortunately, industrial action is the only way to get people talking, and bring the government to the table. MPs' salary in 2010 was £65,738 and has risen year on year to £86,584 today while our pay has been static."

Image source, James Collins

Image source, Doctor handout

The BMA has defended its approach to talks with the government.

Speaking to the BBC earlier today, BMA Council deputy chair and junior doctor Dr Emma Runswick said: "We would absolutely be prepared to suspend strike action and indeed we've been attempting to negotiate since last August."

She added: "It's not us that are preventing there being negotiations happening... it's the government's pre-conditions which are getting in the way of that."

As we mentioned below, Health Secretary Steve Barclay has called doctors' demand for a 35% pay rise unreasonable.

Asked if the BMA was flexible on this point, Dr Runswick replied: "We've never had any pre-conditions ever. We've put our request for pay restoration on the table, we're happy to talk at any point and have been since last August.

"We would be happy to suspend strike action for a credible offer from the health secretary."

Image source, Reuters

Let's bring you some more from the health secretary, who's told reporters his "door remains open" in a bid to bring the ongoing industrial dispute to a close.

In our earlier post, we reported Steve Barclay's comments that union demands for a 35% pay rise for junior doctors were "not fair or reasonable" - but he insisted he wanted to engage in "constructive" talks.

Barclay added: "We recognise junior doctors have been under significant pressure, particularly from the pandemic, and we want to work with them to find a fair and reasonable settlement."

But he also said the timing of the strike was "regrettable" and accused the British Medical Association (MBA) medical union of putting patients at "greater risk" with the latest action.

As junior doctors stage their four-day walkout, Matthew Taylor, chief executive of the NHS Confederation, say people in England should use the health service responsibly over the strikes.

He is urging the public to avoid “risky behaviour” and use NHS services in "the during responsible way you can" during the four-day walkout.

He says to still:

• Call 999 if you have a medical emergency
• Call 111 if you have a medical concern, or use the NHS website

Downing Street insists there will be no pay talks with the BMA union unless junior doctors abandon their starting position of a 35% rise and call off the strikes.

A No 10 spokesman says the figure is "unreasonable and is not affordable for the British taxpayer".

It's "completely out of step with pay settlements in other parts of the public sector" and would cost £2bn, they say, adding that Prime Minister Rishi Sunak is being kept up to date about the impact of the strikes.

Michelle Roberts
Health editor, BBC News online

At the moment, neither side is budging. Without meaningful talks, it's hard to see a resolution.

When junior doctors went on strike in 2016 over pay and conditions, a third party got involved to help settle the stalemate between the government and the British Medical Association (BMA).

It's possible that the same measure might be needed again.

The Advisory, Conciliation and Arbitration Service (Acas) is an independent public body that can act a bit like a referee or a relationship counsellor to get both sides round the table to find a solution.

In 2016 it took 10 days of invenstive talks to break the deadlock.

Image source, Sky pool feed

Health Secretary Steve Barclay says union demands for a 35% pay rise for junior doctors are not "fair or reasonable".

He says there is a need to focus on the wider issues of the economy, including getting inflation down.

"We want to reach a fair and reasonable settlement with junior doctors. We stand ready to have meaningful and constructive talks with them," he tells reporters.

Gem O'Reilly
Live reporter

During the previous strikes last month, I spoke to Dr Mavi Capanna, a psychiatrist based in London. I asked her why junior doctors specifically need better pay, when many professions have seen an erosion of pay due to inflation and the cost of living.

She said there were a lot of "hidden costs" in medicine, which people don’t realise, such as having to "fund a lot of our own training".

"We have to pay for our registration fees and every exam we take, to be able to progress our careers," she told me.

"These additional costs come on top of a decline in pay and a rise in inflation."

Gem O'Reilly
Live reporter

We've been down on the picket line in Manchester, to see why junior doctors there are striking.

"We're striking because we still haven't had any offers at all from [Health Secretary] Stephen Barclay, who hasn't got round the negotiating table with our BMA representatives," says Matt Burrows.

"So while I'd much rather be inside providing care for our patients unfortunately I'm out here on the picket line."

Image source, Doctor handout

Jo Sutton Klein is also a junior doctor - she says it's ridiculous that junior doctor pay is continuing to be cut in real terms.

Image source, Doctor handout

Libby Jones, another junior doctor working in Manchester, says: "The junior doctor is the least paid doctor and that is quite ridiculous given the level of responsibility we have."

5 Live's Nicky Campbell has been asking his audience for their views on the doctor's strikes.

First voice on the programme is junior doctor Annie Brown who is in her first year of practice.

She says on the wards, she is the "first port of call" when someone develops breathing difficulties or if their heart stops.

She says her current salary equates to £14 an hour - although this figure is the subject of some debate once allowances and other payments are taken into consideration.

"I’m already looking at my exit strategy from the UK," she says.

"I love being a doctor and we make a lot of sacrifices to do it and right now it’s not worth it to us."

Image source, Annie Brown

Peter in Essex responds to Annie, saying he feels it's "blackmail" for junior doctors to say they'll leave the country if they don't get a £20,000 increase in their salary.

"Before they go into the job, doctors know the pay and conditions," he adds, "your actions aren't going to get the waiting lists down."

Annie points out the length of university courses and the level of inflation means the reality of junior doctor pay in 2023 is "very different" than it was when they began studying.

"I don't think it's blackmail," she says,"I think it's the reality of the situation we're in."

Dr Layla McCay, policy director of the NHS Confederation which represents hospital trusts, says waiting lists are also going to be affected as a result of postponing "hundreds of thousands of appointments" due to the strikes.

"It's not productive to sit here in a stalemate and it's certainly not sustainable," she tells BBC News.

She says the government and negotiators for junior doctors need to come together and have genuine conversations.

"If they're not able to have those conversations and come to a resolution by themselves, they need to start considering mediation from Acas," she says, referring to the Advisory, Conciliation and Arbitration Service.

Hugh Pym
BBC News Health Editor, reporting from Milton Keynes

Milton Keynes University Hospital says the emergency department is running normally.

Chief executive Joe Harrison told BBC News that consultants had in some cases cancelled holiday plans in order to cover for their junior doctor colleagues.

Experienced nurses and other clinicians, he said, had stepped in to help out and ensure safe staffing levels.

But Harrison made it clear it would be hard to sustain covering junior doctors if strikes continued for any length of time.

The hospital has postponed 200 out patient appointments due today.

Michelle Roberts
Health editor, BBC News online

Ambulance staff and nurses in England have also been striking this winter over pay. They have a different pay contract to junior doctors.

Unions representing them, including the Royal College of Nurses, have negotiated with the government and are recommending that their members now accept a deal.

On offer is a 5% pay rise, plus a one-off payment of at least £1,655 to top up the past year's pay award.

Members have until Friday to cast their vote on whether to accept it.

If they do, it could make it more difficult for the union representing junior doctors to keep pushing for the 35% pay rise - which it says is pay restoration - that it is requesting from the government.

Striking junior doctor Ben has told BBC News says he is now thinking about leaving the profession after a year.

Standing on a picket line outside the Royal Leicester Infirmary, he says: "At the moment every single time you go to work, you have people off sick.

"You have staffing which is only just covering what it needs to.

"And I don't feel I am able to do my best work and I don't feel I'm able to manage the stresses and strains that are put upon me."

He added during his last rotation there would be moments when he'd get panic attacks. and each day he was "completely exhausted and lumbered with responsibility" having only just left medical school eight months ago.

He adds he hopes he can stay in medicine but it was difficult as the job had been "made impossible by the system".