London: Junior doctors in England began their first all-out strike in the nearly 70-year history of the National Health Service (NHS) on Tuesday, a dramatic escalation in a long-running dispute with the government over a new contract.

Junior doctors, a term which covers recent medical school graduates right through to doctors who have been working for well over a decade, walked out from all services including accident and emergency, maternity and intensive care.

NHS England said “military level” planning had gone into making sure that patients in need of urgent care would be properly treated, with more senior doctors known as consultants on hand to provide essential services.

Created in 1948, the taxpayer-funded NHS provides all types of medical care for free to everyone in Britain and is a pillar of national unity, which has made the labour dispute emotive not just for junior doctors but for many members of the public.

At the heart of the conflict is a new contract which the government plans to impose on junior doctors from this summer after months of talks to agree on changes in pay and working hours broke down in January.

The government says the new contract will enable services to be organised in a way that makes it easier for patients to access good care seven days a week, but the doctors say it will result in them working longer hours at anti-social times.

NHS England said some 13,000 elective operations and 113,000 outpatient appointments had been cancelled to free up consultants to provide urgent care during the strike, which started at 0700 GMT and will end at 1600 GMT. There will be another strike during the same hours on Wednesday.

“Tired doctors make mistakes”

There are some 55,000 junior doctors in England, about a third of the medical workforce. NHS services in Scotland, Wales and Northern Ireland, which are managed separately from England, were not affected by the strike.

“None of us wants to strike. We’d all rather be caring for patients at work, but unfortunately we feel this is the only option available to us,” said Joe Mayhew, a striking junior doctor outside St Thomas’s Hospital in central London.

Health Secretary Jeremy Hunt, who has been leading the government’s efforts to bring in the controversial new contract, told the BBC it was a “very, very bleak day” for the NHS and accused the junior doctors of refusing to negotiate sensibly.

The strike is the fifth by junior doctors since the dispute began last year, but during the four previous ones only non-urgent services were affected.

Opinion polls have consistently shown that most members of the public blamed the government for the dispute, although the latest Ipsos MORI poll for the BBC suggested the all-out strike may have eroded support for the junior doctors to an extent.

The poll found that 57 percent of people supported the strike, down from 65 percent ahead of a strike in March.

The new contract increases junior doctors’ basic pay but reduces the number of hours in the week that are considered anti-social and attract additional pay. For example, junior doctors will no longer be paid extra for daytime work on Saturdays.

Hunt says these new arrangements will enable the government to fulfil a campaign promise to deliver “a truly seven-day NHS”.

The doctors say they already do work seven days a week and the new arrangements will damage morale and endanger patient safety. “Tired doctors make mistakes” has been one of the slogans on the picket lines.