Patients are facing three weeks of disruption after junior doctors voted overwhelmingly to go on strike during the run-up to Christmas.

Hundreds of thousands of operations and hospital appointments will be cancelled as a result of three walkouts planned for next month.

A total of 28,316 junior doctors took part in the ballot, of whom 99 per cent voted in favour of staging industrial action and 98 per cent for an all-out strike in protest over new contracts being imposed by Jeremy Hunt. He said today the result was 'very, very disappointing news'.

The contracts would impose conditions that would cut the amount junior doctors can earn for working ‘unsocial’ hours on the evenings and weekends.

Some 98 per cent voted in favour of industrial action following a bitter dispute with Health Secretary Jeremy Hunt

Up to 20,000 people marched through central London on Saturday over Jeremy Hunt's proposed new contract, which means that evening and Saturday work will no longer be paid at a higher rate

To offset the losses, the Health Secretary offered junior doctors a generous 11 per cent basic pay rise, but this was rejected by doctors’ union the BMA.

More than 37,000 doctors were balloted by the BMA, and 76 per cent took part in the vote.

It means an estimated 40,000 junior doctors will strike over three days, providing emergency care only for 24 hours from 8am on December 1, followed by full walkouts from 8am to 5pm on December 8 and 16 where junior doctors will desert wards for the first time in NHS history.

They are expected to cause at least three weeks’ of disruption with operations cancelled in the days leading up to walkouts and afterwards to clear the backlog.

On average, there are 28,000 non-urgent operations and 157,000 consultations in hospitals every day. But December is typically one of the busiest times of the year for urgent cases.

Consultants, nurses and doctors who are not protesting will be asked to cover for striking colleagues. Hospitals are being urged to ask recently retired consultants to work, as they are normally licensed to practise for eight years after they retire. But they will not be able to hire locums to cover striking doctors, as this would be illegal under the 1973 Employment Agencies Act.

The Department of Health is now trying to work out how many patients will be affected – and experts are warning that lives could be lost, cancers diagnosed late and patients left in unnecessary pain if the strikes go ahead.

Katherine Murphy, chief executive of the Patients Association, said she was 'extremely worried by the confirmation that industrial action by junior doctors will go ahead'.

'Patient safety will undoubtedly be put at risk by this decision. Whilst the views of doctors must be heard, the potential consequences of this strike for patients are severe.

'It is not too late for this industrial action to be called off. We call on the Government and the BMA to hold talks to try to resolve the dispute before December 1.

Health Secretary Jeremy Hunt described said contingency plans would be put in place 'to make sure patients are safe'

'We understand it may be difficult for both sides, but if they don't reach agreement then patients will suffer. All sides must work together to find a compromise that is in the best interest of patients.'

Mr Hunt described said contingency plans would be put in place 'to make sure patients are safe'.

Despite the outcome of the vote, the BMA today said it was 'keen to avert the need for industrial action' and has approached conciliation service Acas for talks with the government and NHS Employers.

Dr Mark Porter, chair of the BMA council, said: 'We regret the inevitable disruption that this will cause but it is the Government's adamant insistence on imposing a contract that is unsafe for patients in the future, and unfair for doctors now and in the future, that has brought us to this point.

'Patients are doctors' first priority, which is why, even with such a resounding mandate, we are keen to avert the need for industrial action, which is why we have approached Acas to offer conciliatory talks with the Health Secretary and NHS Employers to clarify the conflicting information coming from Government over the past weeks.

'The Health Secretary is right when he says this action is 'wholly avoidable'.

'Our message to him is that junior doctors have today made their views perfectly clear but that it is still possible to get back around the negotiating table to deliver a contract that is safe for patients, contains the necessary contractual safeguards to prevent junior doctors being overworked and properly recognises evening and weekend work.'

Mr Hunt has warned that the strikes are 'totally unwarranted' and will harm patients.

A new contract, designed to increase working at weekends, is due to be imposed from next summer on doctors working up to consultant level.

It would cut the number of hours on a weekend that junior doctors can claim extra pay for 'unsocial' hours.

To offset the losses, Mr Hunt offered an 11 per cent pay rise, but this was rejected by the BMA.

Currently, 7pm to 7am Monday to Friday and the whole of Saturday and Sunday attract a premium rate of pay.

Under the new plans, a higher rate would run from 10pm to 7am Monday to Friday, and from 7pm on Saturday evenings - a concession on the previous 10pm.

Other proposals are to replace the GP pay supplement - without which GPs would be paid on average around a third less than hospital trainees - and replace it with a 'flexible pay premium'.

Despite the outcome of the vote, the BMA today said it was 'keen to avert the need for industrial action' and has approached conciliation service Acas for talks with the government and NHS Employers

WHAT WILL HAPPEN TO YOUR HOSPITAL? Facing a crisis: Health Secretary Jeremy Hunt Jeremy Hunt will now have to decide whether or not to hold mediation talks with the BMA and Acas. But he is also expected to continue to urge the union to have direct discussions with his officials. Meanwhile, hospitals across the country are being instructed to draw up contingency plans on the assumption that the strikes will go ahead. They are earmarking all non-urgent operations and clinics that can be cancelled on or around strike dates. Staff who are not striking will have to consider cancelling holidays. Bosses will also reschedule meetings and training. Patients whose operations or appointments are cancelled will be notified by phone or letter. If Mr Hunt and the BMA fail to reach an agreement, the first walkout – where junior doctors will only help seriously ill patients – will take place on Tuesday December 1. It will last for a 24-hour period starting at 8am. If they still cannot reach a compromise, junior doctors will stage a full strike from 8am to 5pm on December 8. They will desert hospital wards for picket lines, leaving consultants and nurses to perform their duties. A second full strike is planned for Wednesday December 16, which would see junior doctors walk out between 8am and 5pm. Advertisement

The BMA is concerned this could be removed over time and may only be offered in certain geographic areas.

Mr Hunt has said flexible pay premiums would be applied to more specialities than just general practice and A&E care, with acute medical ward staff and psychiatrists benefiting.

He argues that, under the new deal, just 1% of doctors would lose pay and those would be limited to doctors working too many hours already.

He said maximum working hours per week would fall from 91 to 72.

Dr Johann Malawana, the BMA's junior doctor committee chairman, has said the increase in basic pay is misleading due to the changes to pay for unsocial hours. He said this devalues the vital work junior doctors do in the evenings and at weekends.

The BMA has argued the Government could avoid strikes by offering assurances and lifting the threat that the contract will be imposed.

Guaranteed pay increases linked to time in the job are being scrapped and replaced with a system linked to progression through set training stages.

The BMA argues this affects some trainees, such as women who take time out to have a baby.

WHY ARE DOCTORS GOING ON STRIKE? WHAT DOES IT MEAN FOR PATIENTS? Junior doctors have voted in favour of strike action in a row with the Government over a new contract. What is the dispute about? The Government is intent on introducing a new contract for doctors working up to consultant level to replace one it says is 'outdated'. Health Secretary Jeremy Hunt wants to introduce a 'truly seven-day NHS'. He plans to cut the number of hours on a weekend that junior doctors can claim extra pay. Under the most recent proposals, doctors will receive an 11 per cent rise in basic pay but extra pay for 'unsocial' hours will be cut. What do junior doctors get paid? Currently shifts from 7pm to 7am Monday to Friday and the whole of Saturday and Sunday attract a premium rate of pay. Under the new plans, a higher rate would run from 10pm to 7am Monday to Friday, and from 7pm on Saturday evenings (a concession on the previous 10pm). Other proposals are to replace the GP pay supplement (without which GPs would be paid on average 31 per cent less than hospital trainees) and replace it with a 'flexible pay premium'. The BMA is concerned this could be removed over time and may only be offered in certain geographic areas. Mr Hunt has said flexible pay premiums would be applied to more specialities than just general practice and A&E care, with acute medical ward staff and psychiatrists benefiting. What about fee-paying work? At the moment junior doctors can retain any fees earned for work beyond their NHS duties as long as it does not interfere. Under the new proposals, fees earned would have to be given to a doctor's employer. The BMA says this would constitute a significant loss of income for some doctors in training, and restrict their potential income compared with what is available currently. When will the strikes happen? Junior doctors would only provide emergency care for 24 hours from 8am on December 1, followed by full walkouts from 8am to 5pm on December 8 and 16. Advertisement

'I'm in work Jeremy... are you?': How angry doctors used social media to target the Health Secretary over weekend shifts

NHS staff turned to Twitter to condemn Jeremy Hunt this summer after he lashed out at the health service for the standard of its weekend care.

Dozens of medical staff posted pictures of themselves in uniform with the hashtag #ImInWorkJeremy in a bid to show the Health Secretary their commitment.

It came after Mr Hunt suggested senior staff were not working enough weekend shifts and said top doctors should ‘get real’ about the importance of a seven-day service.

The selfie campaign was launched on Facebook by a trainee doctor and lobby group Keep Our NHS Public supported the campaign on Twitter, writing: 'Hashtag for health workers who want to alert the world when working 24/7 is #ImInWorkJeremy. Hope you're listening @Jeremy_Hunt.'

Doctors from across the country took to the micro-blogging site with many choosing to also divulge how many hours they have had to work in one week.

In an attempt to counter the internet onslaught, at one stage Mr Hunt posted a picture online of himself in scrubs during a visit to a hospital.

He wrote alongside the picture: 'Fascinating visit 2 see brain surgery at UCLH and inspirational leadership of Neil Kitchen. Thx 4 making me welcome' (sic).

However, he came under fire and was accused of breaching patient confidentiality after the image captured a board listing patients on the ward.