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Thousands of patients had hospital clinics cancelled and about 700 operations were postponed across London as junior doctors went on strike for the first time in 40 years.

Picket lines were in place outside 20 of the capital’s hospitals as services were reduced to “Christmas day levels”. Emergency care and treatment for cancer patients was unaffected.

Dr Andy Mitchell, London medical director for NHS England, said the walkouts would “compound the problem” caused by winter pressures – many London hospitals are declaring “black alerts” because they have run out of beds, and a flu alert has been issued.

Dr Mitchell said junior doctors were “clearly highly disillusioned” but pleaded with them to negotiate a settlement rather than continuing their strike.

He told the Standard: “Junior doctors are a crucial part of the NHS workforce but industrial action isn’t without consequences. For patients to have their surgery delayed is terrible and has a massive impact on their lives. It’s not as if these patients are less important by virtue of their condition not being acute or life-threatening.”

Today’s protests were kept deliberately low-key, with many strikers holding “meet the doctors” sessions in train and Tube stations in a bid to explain their case to the public. A poll for Newsnight found 66 per cent of the public backed junior doctors as long as emergency care was maintained.

The action, which continues until 8am tomorrow, will be followed by a 48-hour walkout starting on January 26 and for nine hours on February 10, when junior doctors working in A&E also taking part.

Dr Dagan Lonsdale, a junior doctor at St George’s hospital, said they had been forced into action by the Government’s threat to impose new contracts that would lead to “unsafe” staffing and pay cuts of up to 30 per cent for some doctors. A British Medical Association strike ballot won 98 per cent support.

He told the Standard: “None of us wants to do it. If you speak to any junior doctor, most will have a story about an individual in their lives who inspired them to do medicine. That is certainly true in my case. Taking strike action is the least worst option. If these contacts come into force, it will be so detrimental.”

King’s College hospital and the Princess Royal hospital were forced to postpone 35 elective inpatient operations and cancel 27 outpatient clinics attended by 450 people.

Barts Health, the UK’s biggest trust, with five east London hospitals, said: “Urgent and emergency care only will be provided, so services… will be similar to a Christmas Day.”

Guy’s and St Thomas’ rescheduled 35 non-urgent operations – about 10 per cent of a day’s elective surgery. Imperial, which has five west London hospitals, said “some elective surgery for non-urgent and non-cancer patients” was axed. The Royal Free, which runs three north London hospitals, said 31 inpatient and day-case operations and 14 clinics were cancelled and 71 clincis had fewer appointments than normal.

Croydon hospital chief executive John Goulston said: “It is with real regret that we must postpone 13 planned operations and almost 400 outpatient appointments that had been scheduled to take place.”