Junior doctors in England will begin their longest walkout yet today, in protest over pay.
They say the government's refusal to talk ahead of the five-day strike is "baffling" and "frustrating".
Health Secretary Steve Barclay said doctors' 35% pay demand was "unreasonable" and the strike puts patient safety at risk.
Thousands of planned appointments are being postponed, as emergency and urgent care are prioritised.
The strike starts at 07:00 on Thursday 13 July and ends at 07:00 on Tuesday 18 July.
NHS England said anyone who needs care during the strike should use 999 or A&E in a life-threatening emergency and - for more minor health concerns - contact NHS 111 online or go to the nearest pharmacy.
People will be contacted if their appointment has to be rescheduled. GP and community appointments are unlikely to be affected.
NHS England medical director Stephen Powis said the health service was "entering an incredibly busy, disruptive period" and staff were doing all they can to maintain services and address a record backlog of patients waiting for appointments or treatment.
More than 600,000 NHS appointments in England have already been cancelled or postponed due to strikes by doctors, nurses and other healthcare workers in recent months.
'Horrendous pain is like a hot volcano in my knee'
Richard McKenzie, a marketing manager from Berkshire, is in constant pain waiting for an operation for a new knee which was scheduled for today, but has been postponed because of the strike.
"The pain is like having a hot volcano in your knee and somebody sticks hot needles into the hot volcano. It's horrendous," he says.
"It means you can't sleep, you can't rest - and I can't think either," he says. "Or I have to take such a large load of painkillers that I can't think anyway."
He said his situation is "completely" affecting his life: "When you're in pain all the time you get crabby, it affects relationships, it affects how you work, it makes you snappy. It's always there and you can't get away from it."
Richard is not confident his operation will happen on the rescheduled date in a few weeks time either.
And he's worried about the impact of constant delays on his work, which requires regular travel to Germany.
Why are doctors striking?
Junior doctors say pay rises they've received for the last 15 years have been below inflation, and a 35% pay increase is now needed to make up for that.
The British Medical Association (BMA) union, which represents doctors, said a government offer of a 5% pay rise was not "credible".
Some 86% of British Medical Association members backed the latest walkouts, which are the fourth strike by junior doctors in England since the pay dispute began.
Junior doctors make up around half of all hospital doctors in England and a quarter of all doctors working in GP surgeries. The BMA represents more than 46,000 junior doctors in the UK.
Meanwhile, planned strikes by junior doctors in Scotland this week were called off after a new pay deal was offered - a 17.5% increase over two years.
Health and Social Care Secretary Steve Barclay said the pay demand of 35% by junior doctors in England "risks fuelling inflation, which makes everyone poorer".
"If the BMA shows willingness to move significantly from their current pay demands and cancels these damaging and disruptive strikes, we can get around the table to find a fair deal to resolve this dispute," he said.
The BMA junior doctors' committee urged the government to "reassess their entrenched position" and get back to talks.
More senior doctors - consultants - who are filling in to provide emergency care during this strike, will be going on strike themselves on Thursday 20 and Friday 21 July.
Consultants will be providing what is being described as "Christmas Day cover" - emergency care will be provided, along with a very limited amount of routine work.
Apart from strikes, hospitals have faced other challenges to get back to full capacity since Covid hit. These include staffing shortages, more emergency patients and problems discharging patients because of the lack of care in the community.
More than 7.3 million people are on the waiting list at the moment - nearly three million more than before the pandemic.
One in 20 has been waiting more than a year - although the NHS has got close to eliminating waits of more than 18 months.
Radiographers, who carry out scans on patients, have agreed to strike over pay in some parts of England this month too.
Are you a doctor with a view on the strike? Are you a patient affected? Share your experiences by emailing haveyoursay@bbc.co.uk.
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2023-07-12 23:09:59Z
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