Junior doctors across England have launched a four-day strike in a worsening dispute over pay which threatens huge disruption to the NHS.

An estimated 350,000 appointments, including operations, will be cancelled as a result of the walkout by members of the British Medical Association (BMA).

The Wye Valley NHS Trust, which runs Hereford County Hospital, said it was "working hard" to maintain services during the strikes.

It told patients who need medical help or advice to use NHS 111 online.

If it is life-threatening call 999, and anyone with a hospital appointment should attend as usual, unless contacted by the hospital.

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Doctors mounted picket lines outside hospitals from 7am on Tuesday until Saturday morning in the longest stoppage of the wave of unrest, which has seen nurses, ambulance crews and other health workers take action since last year.

Health and Social Care Secretary Steve Barclay said the walkouts risk patient safety.

Managers have said patient care is “on a knife edge” because of the strike, while NHS Confederation chief executive Matthew Taylor said the number of appointments cancelled, previously suggested to be 250,000, was likely to rise by another 100,000.

The strikes centre around a pay row between the BMA and Government, with the union claiming junior doctors in England have seen a 26 per cent real-terms pay cut since 2008/09 because pay rises have been below inflation.

The union has asked for a full pay restoration that the Government said would amount to a 35 per cent pay rise – which ministers have said is unaffordable.

BMA officials said the pay issue is making it harder to recruit and retain junior doctors, with members previously walking out for three days in March.

Alex Pavlimby, a second year foundation doctor at the Wye Valley NHS Trust, said while striking in March: "We're striking for full restoration of pay for junior doctors working across England. We believe the salary doesn't reflect the hard work, long hours and dedication that we put in this job.

"We're asking for a pay restoration to level the standards that we saw in 2008.

"We're seeing a lot of patients come through the door and it's tremendous hard work for the hours that we do, so it is really difficult.

"We all love the job, we all really enjoy it but we think the work and effort that we put in should be reflected by the suitable pay restoration of 2008."

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National medical director of NHS England Professor Sir Stephen Powis said on Sunday the strikes will put “immense pressures” on staff and services.

NHS England said staff will be asked to prioritise emergency and urgent care over some routine appointments and procedures to ensure safe care for those in life-threatening situations.

The health body said appointments and operations will only be cancelled “where unavoidable” and patients will be offered alternative dates as soon as possible.

Health and Social Care Secretary Steve Barclay said: “It is extremely disappointing the BMA has called strike action for four consecutive days.

“Not only will the walkouts risk patient safety, but they have also been timed to maximise disruption after the Easter break.

“I hoped to begin formal pay negotiations with the BMA last month but its demand for a 35 per cent pay rise is unreasonable – it would result in some junior doctors receiving a pay rise of over £20,000."

The BMA has previously said it was willing to enter talks with Mr Barclay and suspend strikes if members were presented with a “credible” pay offer “to resolve 15 years of pay erosion”.