Junior doctors have walked out for a second 24-hour strike amid the ongoing bitter row with the government over pay and conditions.
Thousands of operations, check-ups and tests have been cancelled as a result of the industrial action, which started at 8am.
Junior doctors at the Queen Elizabeth Hospital in Birmingham and the Royal Derby Hospital were among those on strike across the Midlands.
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Junior doctors have been told what to do if a trust declares a major emergency during the strike.
During the last junior doctors' strike, Sandwell Hospital in West Bromwich declared a level 4 incident and told its junior doctors they must attend work.
As you know when we last took industrial action there was some confusion about when trusts could call junior doctors back into work.
In addition to the legal advice we took at that time we now have a joint letter signed by Sir Bruce Keogh of NHS England and the BMA's Mark Porter setting out the protocol should a major unpredictable incident occur.
According to the letter, junior doctors can be requested to work if:
- There is both "exception and sustained deterioration in performance such as to endanger patient safety and cannot be managed through the deployment of the hospital’s senior hospital doctors and the junior doctors providing emergency care".
- The Trust must make a formal request to NHS England, who will then contact the BMA.
Thousands of junior doctors across England have gone on strike and only emergency care will be provided during the 24-hour walkout.
Thousands of junior doctors across England are going on strike after last-ditch talks failed to reach an agreement.
Junior doctors - which refers to all doctors below consultant level - will only provide emergency care from 8am Wednesday morning in the 24-hour walkout.
It is the second day of strike action by the British Medical Association (BMA) in a bitter dispute with the Government over a new contract.
It is understood the BMA put forward a proposal that would have seen doctors' basic pay rise by about half the 11% offered by ministers in return for Saturday not to be treated as a normal working day.
The union argued it would have been cost neutral, meaning the Government would not pay any more than the £5bn currently spent on junior doctor salaries.
But it is thought the Government blocked that deal.
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