Commenting on the first day of the British Medical Association (BMA) junior doctors' 72-hour strike, Sir Julian Hartley, chief executive at NHS Providers said:

"Trust leaders have had to manage a demanding start to what was already going to be a very tough week involving strikes.

"In the days leading up to this walkout, a number of emergency departments were under significant pressure with several reporting record attendances.

"One trust saw over 1,000 people present across their two emergency departments in just one day – hundreds more patients above what's usually considered very high.

"Minor injuries units have also been under stress, with lots of patients with respiratory issues amid rising pollen and pollution levels, as well as dehydration due to the heat.

"Trust leaders' priority is to keep patients safe and deliver high-quality care, but this is becoming increasingly challenging as strikes continue. It's also becoming significantly more expensive due to the cost of covering staff on the picket line.

"More than half a million appointments and procedures have had to be postponed due to industrial action since December, and the chief executive of NHS England today warned this figure will likely rise by tens of thousands this week.

"We cannot go on like this. We urge the government and unions to re-enter negotiations so we can put an end to this disruption and focus on treating patients."