Thousands of junior doctors are walking off the job again today for an unprecedented fifth strike.

Photo: RNZ / Karen Brown

The five-day strike - everywhere except Canterbury - began at 8am and will end early Saturday.

Members of the junior doctors' union, the Resident Doctors' Association are striking at all public hospitals except in Canterbury which has been excluded because of the recent terror attacks.

District health boards say they cannot estimate how many non-urgent operations, appointments and clinics have been postponed because of the strike.

They said last week this is because the effects will vary, and some hospitals are waiting to see how many doctors will be working before they make a decision.

The Counties Manukau DHB in South Auckland said 1039 outpatient appointments have been deferred because of the strike, including appointments already booked and some appointment slots yet to be filled. As well, 45 operations have been deferred, and at least 16 gastroenterology procedures.

The DHBs' national contingency planner, Anne Aitcheson, said generally speaking public hospitals managed well on the first morning of the strike.

She said discharging patients who are well enough to go home is a focus for hospitals today, but everything is going as planned.

Hospitals have stressed emergency and acute care will be their priority during the strike.

The main sticking point is that district health boards want hospital chief executives to have the final say over working arrangements - including rosters - rather than the union head office.

Junior doctors say they are striking to prevent clawbacks to long-standing terms and conditions of employment.

'There will be ongoing strike action'

A junior doctor at Hutt Valley DHB and president of the Resident Doctors' Association, Courtney Brown, told Morning Report doctors wanted the current employment contract to remain unchanged.

The current contract has limits on hours worked with particular regard to rosters.

"Currently, we have provisions in our contract, particularly limits on how many days ... how many night shifts ... and how many hours we can work in a row."

These can be varied with the union's agreement, Ms Brown said.

"What the DHBs want to do is either agree with an individual RMO (Resident Medical Officer) locally. However, if those RMOs locally disagree they want the CEO to have the final say anyway.

"They want to be able to enforce changes upon us without our agreement."

The previous four strikes have resulted in them going to facilitation, she said.

"The point of this fifth strike is to try to ensure that we get a settlement at the end of that process.

"There will be ongoing strike action until we get a contract we can settle."

District Health Boards spokesperson Dr Peter Bramley told Morning Report this strike was "disappointing and very frustrating".

"We absolutely hope there's not another strike. This strike is completely unreasonable and unnecessary."

He said through all of last week, teams had been preparing to ensure they could provide safe, acute and emergency care.

"We formally asked the RDA to lift this strike. We don't see this strike at all being necessary given that we've already agreed to meet at facilitation on 9 May."

Photo: RNZ / Matthew Theunisson

Dr Bramley said the DHBs were not looking to clawback any of the employment conditions.

"What we're wanting though at a local DHB level to have this flexibility to make the roster changes that support better care, a better medical team and better training for RMOs.

"At the moment it's a one-size-fits-all approach and unfortunately, the union has the veto power.

"We want changes to that power of veto."

He said he was positive about reaching an agreement.

"We're confident we can, in part because we've reached the agreement that allows for that flexibility with the other union representing the RMO workforce - Specialty Trainees of New Zealand, in which there are 750 members now. We've got an agreement with them that we think is both constructive and supportive, firstly in safe care, but also in better training environment," Dr Bramley said.

"We're looking for the same flexibility with the RDA agreement."

DHBs spent $15m 'fighting their own doctors' - union leader

Resident Doctors' Association senior advocate David Munro said if DHBs expected the RDA to settle for an "inferior" deal, and if that's the attitude they were taking to facilitation, then this dispute might go on longer.

"Our members have instructed us very clearly that they want to keep the pressure on through strike action," he told Morning Report.

The RMOs hadn't seen any preparedness from the DHBs to compromise, he said.

"Any indication that the DHBs are coming with an open mind to compromise has simply not been there yet.

"They [the DHBs] want to have rosters that will lead to fatigued doctors, and fatigued doctors make mistakes.

"This, from the DHBs' point of view can come down to money which makes it all the more appalling that they've spent $15 million in strikes so far, fighting their own doctors."