Hospital doctors in England on Wednesday began their longest strike in the 75-year history of Britain's National Health Service as they walked off the job for six days.
The disruption by thousands of junior doctors – who make up nearly half the state-funded NHS doctor workforce – will see tens of thousands of patients have their care cancelled.
It comes at one of the busiest times of the year when the NHS faces increased pressure from winter respiratory illnesses.
The strike marks a major escalation of the doctors' long-running pay dispute with the British government.
Pay talks between the British Medical Association (BMA) and the government broke down last month, and it's feared the action will bring routine services to a standstill in some areas.
Tough start to year
The NHS said the stoppage, which follows a three-day strike held by doctors just before Christmas, could see up to half of the medical workforce on picket lines.
"This January could be one of the most difficult starts to the year the NHS has ever faced," said NHS national medical director, Stephen Powis.
The Patients Association charity said patient safety could be compromised because hospitals had too few staff to cope with the industrial action.
It urged ministers and the BMA to bring in mediators.
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However Health Secretary Victoria Atkins said junior doctors needed to call off their strike before she was prepared to return to the negotiating table.
The BMA rejected a pay offer made by the government in December, saying it failed to compensate for pay cuts going back as far as 2008.
The strike is the 10th different stoppage by British junior doctors since March that has forced the rescheduling of 1.2 million appointments and operations.
The NHS was founded three years after World War II on the principle that everyone should access top-quality healthcare funded by general taxation, free at the point of care.
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