Almost 90% of doctors at some hospitals refuse to work as battle with health secretary escalates and PM criticises withdrawal of emergency care

Four out of five junior doctors took part in the first all-out strike in NHS history on Tuesday, as David Cameron blasted their withdrawal of emergency care.

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At some hospitals, almost 90% of junior doctors refused to work between 8am and 5pm, in an escalation of their campaign against the new contract that Jeremy Hunt intends to impose on them.

However, most hospitals coped well and did not experience any problems, with senior medics taking on duties usually undertaken by their junior colleagues. A&E units were quieter than usual as patients with minor ailments heeded NHS warnings to stay away.

Junior doctors – all those below the level of consultant – will stage a second all-out strike on Wednesday during the same hours.

Dr Johann Malawana, chair of the British Medical Association’s junior doctors committee, said: “The overwhelming turnout at almost 150 picket lines across England today shows the strength of feeling amongst junior doctors against the government’s plans. Tens of thousands protested against a contract they believe is unfair and damaging to patient care in the long term.”

None of England’s 156 acute hospital trusts reported any patient safety incident or sudden inability to cope with demand that might have led them to ask striking doctors to return to work, allaying fears that patients might come to harm because of the absence of so many medics.

Figures released by NHS England showed that 21,608 junior doctors – 78% of those due to work – participated in the industrial action. It claimed that this was down from the 88% who did so on each day during the previous strikeon 6-8 April. However, the 88% figure raised questions as NHS England had previously said that almost half of doctors had worked on those days.

Turnout was highest at Barts Health, the largest trust in the NHS. The London trust said that 88.4% of its 1,000 junior doctors had joined the walkout.

After four previous strikes, Tuesday was the first one to affect areas of life-or-death treatment, such as A&E, maternity and intensive care. At the two hospitals run by King’s College hospital trust in south London, none of the 13 trainee obstetricians and gynaecologists turned up and nor did any of the 26 junior doctors working in its critical care unit. However, 16 of the 22 junior doctors in its emergency department did work as normal.

At the South London and Maudsley NHS foundation trust, only 40 out of 246 trainees worked – an 84% turnout. Turnout elsewhere was 81% in Ipswich, 74% at the Royal Free in London, 64% in Blackpool and Stoke and 63% in Bournemouth.

Will Denby, a GP registrar in Hampshire, said that he opposed the action because withdrawal of care in emergency areas of care threatened the bond of trust between doctors and patients.

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“The strike is now wholly unfortunate, regrettable and damaging. I would like to hope that all parties wish it had never come to this – no one will come out of it well,” he said.

“I don’t support withholding emergency care. I don’t think it directly causes harm, or affects safety, but it affects our relationship with the people we serve. Our profession has to have trust with the society we serve at its heart, and while I agree there is a longer-term view in all-out striking, for me a line is crossed. I would support continued striking, but not over acute and emergency care.”

NHS services ran smoothly, although 13,000 operations and 113,000 outpatient appointments had already been cancelled as a direct result of this week’s strikes. Surgeons reported that very few trainees had turned up for work and that consultants had coped well with their workload.

The prime minister said the unprecedented action was unjustified because junior doctors had been promised a 13.5% rise in their basic pay to make up for having to work more antisocial shifts.

He defended the health secretary’s robust handling of the eight-month-old dispute, which has caused disquiet in the medical profession. “There is a good contract on the table, with a 13.5% increase in basic pay – 75% of doctors will be better off with this contract,” Cameron told ITN.

“It’s the wrong thing to do to go ahead with this strike, and particularly to go ahead with the withdrawal of emergency care – that is not right.”

A new opinion poll shows that 59% of people across the UK support the junior doctors, even though they have resorted to all-out strikes to try to thwart Hunt. However, the survey by OnePulse, a mobile app, found that support had fallen by six percentage points from the 65% backing recorded last month.