<a href="https://www.thenationalnews.com/world/uk-news/2023/09/19/doctors-strike/" target="_blank">Junior doctors</a> in England have rejected pleas from hospital bosses to return to work to deal with medical emergencies during industrial action over pay. More than 20 requests were made by hospitals on Wednesday, citing “extreme pressure” and safety fears, just hours into the doctors’ six-day walkout. <a href="https://www.thenationalnews.com/health/2022/10/11/nhs-in-danger-of-complete-collapse-says-medical-association/" target="_blank">The British Medical Association (BMA)</a> said most of the requests had been denied as it criticised <a href="https://www.thenationalnews.com/tags/nhs/" target="_blank">National Health Service (NHS)</a> officials for not submitting the requests properly and putting the union in an “impossible” situation. On the first day of the strike, more than a dozen hospitals said emergency services were “busy”. Queen Alexandra Hospital in Portsmouth said its Accident and Emergency department was “full” as it declared a critical incident. A critical incident was also declared by NHS Nottingham and Nottinghamshire Integrated Care Board due to “significant pressures on services”. Other hospitals reported “extreme heightened pressure” and being “exceptionally busy”, with one citing A&E waits of “up to 11 hours”. A four-day strike by junior doctors in December resulted in 33,000 appointment cancellations. NHS management estimates that 304,000 acute outpatient appointments have been cancelled due to the industrial action over the past year. But NHS officials stressed that people should still seek care when they need it. Dr Vin Diwakar, medical director for transformation at NHS England, said officials had spent weeks doing “intensive preparation” for the strike. “We have been prioritising emergency care as we have done during previous industrial action,” he said. Professor Sir Stephen Powis, national medical director for the NHS in England, said the strike coincides with “one of the busiest and most challenging weeks of the year” as the health service grapples with increased pressure from winter viruses and people coming forward who delayed seeking help over the holidays. Health and Social Care Secretary Victoria Atkins urged <a href="https://www.thenationalnews.com/world/uk-news/2023/03/23/junior-doctors-name-four-more-strike-days-for-april/" target="_blank">junior doctors </a>to call off the strike and “come back to the negotiating table”. Dr Vivek Trivedi, co-chairman of the BMA's junior doctors committee, said he hoped the government would restart talks. “But from all of the signals they are sending it won't be until our strike action finishes. And I hope at that point we can come to a resolution,” he said. The BMA said junior doctors' pay has been cut by more than a quarter since 2008. Last summer, the government gave junior doctors in England an average rise of 8.8 per cent, but medics said the increase was not enough and ramped up strike action. The NHS is one of the world biggest employers with 1,308,825 full-time staff in September 2023, an increase of 5.6 per cent over a year. Late last year, the government and <a href="https://www.thenationalnews.com/world/uk-news/2023/01/06/nhs-junior-doctors-in-england-will-strike-for-three-days-in-march-if-vote-passes/" target="_blank">junior doctors</a> entered talks, but the negotiations broke down after five weeks and more strikes were called. Junior doctors from the Hospital Consultants and Specialists Association union will join colleagues on picket lines. Consultants and speciality and associate specialist doctors have agreed a deal with the government, which is being put to members.