Doctors who have been working for the NHS for less than two weeks are among those downing tools this morning and going on strike.
Junior doctors from the British Medical Association (BMA) are staging a four-day walkout from 7am in an ongoing dispute over pay.
Concerns have been mounting over the impact of the strike following a High Court ruling that means the NHS cannot use agency staff to backfill striking workers.
Almost 835,000 appointments have been postponed since industrial action began in December.
But NHS Confederation said the true level of disruption is being “masked” and the number of cancellations could be double this figure.
It said many hospitals have stopped booking in routine activity on potential strike days to prevent causing more disruption to patients on waiting lists, and the action was hampering efforts to reduce the record backlog of care.
Sir Julian Hartley, chief executive of NHS Providers, warned the figure could close in on one million postponed appointments following strikes by junior doctors and consultants in August, as well as a potential further two-day strike by consultants in September.
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“There will be a long-lasting effect on patients who have had treatment delayed and on already low staff morale,” he added.
Making room for rescheduled appointments could also mean those further down the waiting list also face delays.
Health Secretary Steve Barclay said: “Patients are bearing the brunt of the impact of continuous strikes across the NHS, and further action by the BMA will cause more appointments and procedures to be postponed.
“Our award balances the need to keep inflation in check while recognising the incredibly important work they do.
“My door is always open to discuss how to improve doctors’ working lives, but this pay award is final so I urge the BMA to end its strikes immediately.”
The BMA are demanding a 35% increase, arguing junior doctors have lost more than a quarter of their pay over 15 years as a result of salaries not keeping up with inflation.
But the government said a 6% uplift given to junior doctors, which it says is the equivalent to an average increase of 8.8% – in addition to a consolidated £1,250 rise – is “fair and reasonable”.
The action will include some medics who only started their jobs with the NHS last Wednesday.
Dr Omolara Akinnawonu is one of those Foundation Year 1 doctors who started her role on 2 August. She said many medics struggle to make ends meet when they first start in the health service.
“I don’t think many of us as students imagined that we will be having to take to picket lines but I think that it’s necessary because it’s safeguarding our right now and also our future,” the 24-year-old said.
“We sort of graduated at the backfoot and to arrive finally as a doctor to not receive a fair salary is not fair.”
Sir Keir Starmer has said he will defend the decisions made in the budget “all day long” amid anger from farmers over inheritance tax changes.
Chancellor Rachel Reeves announced last month in her key speech that from April 2026, farms worth more than £1m will face an inheritance tax rate of 20%, rather than the standard 40% applied to other land and property.
The announcement has sparked anger among farmers who argue this will mean higher food prices, lower food production and having to sell off land to pay for the tax.
Sir Keir defended the budget as he gave his first speech as prime minister at the Welsh Labour conference in Llandudno, North Wales, where farmers have been holding a tractor protest outside.
Sir Keir admitted: “We’ve taken some extremely tough decisions on tax.”
He said: “I will defend facing up to the harsh light of fiscal reality. I will defend the tough decisions that were necessary to stabilise our economy.
“And I will defend protecting the payslips of working people, fixing the foundations of our economy, and investing in the future of Britain and the future of Wales. Finally, turning the page on austerity once and for all.”
He also said the budget allocation for Wales was a “record figure” – some £21bn for next year – an extra £1.7bn through the Barnett Formula, as he hailed a “path of change” with Labour governments in Wales and Westminster.
And he confirmed a £160m investment zone in Wrexham and Flintshire will be going live in 2025.
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‘PM should have addressed the protesters’
Among the hundreds of farmers demonstrating was Gareth Wyn Jones, who told Sky News it was “disrespectful” that the prime minister did not mention farmers in his speech.
He said “so many people have come here to air their frustrations. He (Starmer) had an opportunity to address the crowd. Even if he was booed he should have been man enough to come out and talk to the people”.
He said farmers planned to deliver Sir Keir a letter which begins with “‘don’t bite the hand that feeds you”.
Mr Wyn Jones told Sky News the government was “destroying” an industry that was already struggling.
“They’re destroying an industry that’s already on its knees and struggling, absolutely struggling, mentally, emotionally and physically. We need government support not more hindrance so we can produce food to feed the nation.”
He said inheritance tax changes will result in farmers increasing the price of food: “The poorer people in society aren’t going to be able to afford good, healthy, nutritious British food, so we have to push this to government for them to understand that enough is enough, the farmers can’t take any more of what they’re throwing at us.”
Mr Wyn Jones disputed the government’s estimation that only 500 farming estates in the UK will be affected by the inheritance tax changes.
“Look, a lot of farmers in this country are in their 70s and 80s, they haven’t handed their farms down because that’s the way it’s always been, they’ve always known there was never going to be inheritance tax.”
On Friday, Sir Keir addressed farmers’ concerns, saying: “I know some farmers are anxious about the inheritance tax rules that we brought in two weeks ago.
“What I would say about that is, once you add the £1m for the farmland to the £1m that is exempt for your spouse, for most couples with a farm wanting to hand on to their children, it’s £3m before anybody pays a penny in inheritance tax.”
Ministers said the move will not affect small farms and is aimed at targeting wealthy landowners who buy up farmland to avoid paying inheritance tax.
But analysis this week said a typical family farm would have to put 159% of annual profits into paying the new inheritance tax every year for a decade and could have to sell 20% of their land.
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The Country and Land Business Association (CLA), which represents owners of rural land, property and businesses in England and Wales, found a typical 200-acre farm owned by one person with an expected profit of £27,300 would face a £435,000 inheritance tax bill.
The plan says families can spread the inheritance tax payments over 10 years, but the CLA found this would require an average farm to allocate 159% of its profits each year for a decade.
To pay that, successors could be forced to sell 20% of their land, the analysis found.