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Sally Knight started feeling pain in her hip at the start of 2023.

It was decided the 69-year-old needed a hip replacement - but after having two appointments cancelled because of strike action and being told the wait could be a year, she decided to pay to have the surgery privately. It cost her more than £13,000.

Ms Knight said she had felt she had no choice - the pain had been affecting her daily life.

"I feel really frustrated because I've worked all my life and paid my dues," she said.

"Yes the help is there - but you have to wait a very long time. I feel very let down."

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Sir Julian Hartley, chief executive of NHS Providers, which represents health managers, said this set of strikes meant the "worst fears" of the health service were being realised.

"This is the last thing the NHS needs," he said. "The quality of care will be affected, with efforts to cut waiting lists further dented by these walkouts."

Dr Robert Laurenson and Dr Vivek Trivedi, who co-chair the BMA junior doctors committee, said they were "extremely disappointed" to be taking action again - the last walkout was in early October.

"We had hoped that after a much-improved tone and approach from the new health secretary, Victoria Atkins, we were close to a solution to this dispute," they said.

Dr Laurenson and Dr Trivedi urged the government to make a new offer - the BMA ended talks after setting a deadline of early December for a resolution.

An offer of a pay rise averaging 3%, from January, was being discussed, which would have been on top of the average of nearly 9% junior doctors received in April.

But the BMA said that was too little - junior doctors had asked for an extra 35%, to make up for below-inflation pay rises since 2008.

"After so many missed opportunities in 2023 to settle the dispute, surely now is the moment to conclude that everyone's time would be saved by cutting out unnecessary posturing," Dr Laurenson and Dr Trivedi said.

"Patients in need of care deserve nothing less."

Ms Atkins said the strikes would cause "significant disruption", despite contingency measures.

"My door remains open should the BMA cancel these disruptive strikes and come back to the negotiating table, as we were making good progress," she added.

Industrial action in the NHS in England, which began last December with walkouts by ambulance staff and nurses, is estimated to have cost more than £2bn in planning, preparations and paying for cover.

A pay offer to NHS staff other than doctors was accepted in May, while strike action by consultants has been put on hold as they vote on a fresh offer from the government.