Junior doctors were told to defy orders from a West Midlands hospital to return to their wards just two hours into a strike because of pressure on services.

In the first strike by hospital doctors in 40 years, as many as 38,000 members of the British Medical Association (BMA) across England began the action at 8am on Tuesday. The 24-hour strike over a new pay and working hours contract proposed by the government has meant hospitals have rescheduled about 4,000 non-emergency operations, 13% of the normal daily total.



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The doctors have agreed to provide emergency care for the first of two planned strikes this month but have threatened to withdraw those services in a third strike in February.

Within two hours of the start of the strike, Sandwell hospital in West Bromwich said it had declared a level four incident and told its junior doctors they must attend work. The BMA, however, said they should refuse to do so until the seriousness of the situation had been established through the correct process.

The hospital later stood down its request for doctors to return and said the order from the trust had not been politically motivated.

The original letter from the trust, dated Monday, told doctors rostered on for Tuesday that they should report for duty and said the hospital was already at escalation level four. “There are over 50 additional adult beds open with further medical outliers in surgery,” it said.

Shaun Lintern (@ShaunLintern) Letter to junior doctors from Sandwell Hospital: pic.twitter.com/dFolyXQyVz

Dr Roger Stedman, medical director at Sandwell and West Birmingham hospitals NHS trust, said Sandwell had had very high numbers of patients come to the hospital, and fewer than usual discharged. Staff striking at Birmingham City hospital were unaffected, he added.

Several junior doctors working for the trust questioned why the situation had been labelled an emergency, other than to undermine strike action.

“We received the letter emailed to us this morning, but it was dated yesterday and it said the situation had been ongoing for some days,” one doctor, who wished to remain anonymous, said. “We were not called in at the weekends to provide extra cover to discharge patients, so why are we getting called in now?

“This kind of situation happens all the time, especially in winter, over the whole NHS,” he continued. “You’d expect it to happen several times a year. It’s not at all unusual. I would imagine it’s the same situation with hospitals across the country. So it’s odd that this has happened to junior doctors on the day of the strike, when the issue of discharges has been going on for a few days.”

Facebook Twitter Pinterest Doctors and supporters outside Sandwell hospital. Photograph: Christopher Furlong/Getty Images

Dr Anne De Bray, who has worked at the hospital for a year, said: “My first reaction was to cry when they called us back in.

“It’s been well planned. They said they would call us individually if they needed us to come back into work. Instead they’ve emailed us a letter that was dated yesterday, 15 minutes before our picket line was due to start.

“I just think they’ve not done it through the proper channels. If there had been a major incident like a terrorist attack or road accident we would drop our placards and head in.”

Another junior doctor, who did not want to be named, added: “It is disgraceful they’ve tried to trick us back into work. The sad thing is some doctors would have fallen for it and gone back in. There is no major incident. It is just busy, which they have known about for a long time so they had plenty of time to put arrangements in place.”

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The BMA advised doctors not to return to work unless there was “a major unpredictable incident ... taking place for a specific trust.”

Shortly after 4pm, the hospital’s chief executive, Toby Lewis, said the hospital had managed to cope with the increased numbers and said he had agreed to stand down the requests for trainees to come in.

Sandwell has fiercely denied it has any political motivation. “The trust is not party to the national dispute in any way,” Lewis said.

“The decisions made were made locally, and based on judgments about current and foreseeable pressure – a recognised basis for incident management. It would be irresponsible to wait for a position that was not recoverable and then act.”

Earlier, Prof Sir Bruce Keogh, the NHS medical director, told hospitals they should order doctors back to work if services became dangerously overstretched.

In a letter to NHS trusts published by the Telegraph, Keogh said on Monday that doctors should be told to return if there was an “exceptional and sustained deterioration in performance”, which the BMA said was meddling with doctors’ right to strike.

Dr Johann Malawana, the chair of the BMA’s junior doctors’ committee, said Keogh’s letter was a “last-minute, inept and heavy-handed attempt to bully junior doctors lawfully taking industrial action back into work”.

The health secretary, Jeremy Hunt, told the BBC he was disappointed the strikes had gone ahead. “This is a wholly unnecessary dispute,” he said. “We want all NHS patients to have the confidence that they will get the same high-quality care every day of the week.

“At the moment, if you have a stroke at the weekends, you’re 20% more likely to die. That cannot be right. The right thing to do is to sit round the table and talk to the government about how we improve patient safety and patient care, not these very unnecessary strikes.”

The Labour leader, Jeremy Corbyn, urged ministers to apologise for the failure to avert a strike. In a post on Facebook, he wrote: “No NHS worker takes lightly the decision to strike, but the blame must be laid at the door of this government for the way it has treated doctors and now seeks to smear them in the press. It is time for this government to apologise to junior doctors and negotiate a fair deal that gets our NHS working again.”

Facebook Twitter Pinterest A junior doctor holds her baby and a placard outside Kings College hospital in London. Photograph: Carl Court/Getty Images

Sir Robert Francis QC, who led the inquiry into the Mid Staffordshire scandal and is a non-executive director of the Care Quality Commission, said industrial action would compromise patient safety.

He told BBC Radio 4’s Today programme: “The only way that matters can be solved for doctors and patients is for talks to continue and for emergency care not to be withdrawn.”

Francis also said the government should listen to doctors and explain their offer more clearly.

“I quite understand why many of them [doctors] feel angry. They need to be listened to. One thing I would ask is done is that a better explanation is given to them all as to what the effects of any offer being made on them is personally. I’m not entirely confident that that has yet happened.”

The BMA said it had been forced to act after ministers refused to heed its concerns that the new contract proposed by Hunt would be unfair on doctors and compromise patient safety. About 98% of its members backed strike action in a ballot in November.

They are opposed to Hunt’s plan to classify Saturday as part of a junior doctor’s normal working week, for which they are paid at only the basic rate. He also wants to see weekday evening hours classified as normal time extended from 7pm to 10pm, but junior doctors fear this will lead to cuts in their pay.

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Hunt has offered to raise junior doctors’ basic pay by 11% to offset the loss of overtime they currently earn for working in the evening and on Saturdays, and has promised that no junior doctor will be worse off under the new contract, which is due to start in August.

A new opinion poll suggests that despite Hunt’s efforts to portray the walkout as politically motivated and based on misinformation from the BMA, the public is largely behind the strike. An Ipsos Mori poll for the Health Service Journal found that 66% of 869 people support action such as that planned on Tuesday – in which juniors due on duty in emergency care still turn up to work – with only 16% completely against.

Katherine Murphy, chief executive of the Patients Association, said that while she sympathised with the junior doctors, industrial action would cause “a great deal of distress for many patients, who continue to be caught in the middle of this dispute”.

She urged the BMA and ministers to resume talks as soon as possible to agree a deal before the second of three planned strikes, from 26 to 28 January.