Junior doctors in England have overwhelmingly voted in favour of going on strike in their dispute with ministers over a new contract. Some 98% voted in favour of a full strike and 99% in favour of action just short of a full strike. The first walk-out will start on 1 December with another two dates earmarked for later in the month. The British Medical Association said it was "inevitable" disruption would be caused to patients. The action is likely to lead to the cancelling and rescheduling of thousands of routine appointments, tests and operations with the NHS forced to prioritise emergency cases. BMA leaders said they regretted this, but added ministers had left them no choice because the contract was "unsafe".

The union has asked the Advisory, Conciliation and Arbitration Service (Acas) to get involved to offer independent arbitration - something the Academy of Medical Royal Colleges, which normally stays out of politics, has said it supports. The dates for industrial action are:

08:00 GMT 1 December to 08:00 GMT 2 December (junior doctors to staff emergency care)
08:00 GMT to 17:00 8 December (full strike)
08:00 GMT to 17:00 16 December (full strike)

The BMA balloted just over 37,700 members - over two-thirds of the workforce - and 76% took part in the ballot.

What will happen in a strike?
Services will be disrupted, make no mistake about that. But the British Medical Association argues the aim of doctors taking part will not be to maximise that - as is the goal in many other industrial disputes. On the first day of action that has been earmarked, junior doctors will still staff emergency care. On the other two dates, they will walk out in the knowledge there will be other medics - consultants, staff doctors and locums - that can plug the gaps. Whether that will be enough for hard-pressed emergency services will be argued over ahead, during and after any walkout. What is certain, though, is routine services will suffer. Hip operations, knee replacement and routine clinics will have to be cancelled.

In fact, as happened the last time doctors took action in 2012, over pensions, expect hospitals to start rearranging services in advance. The vote comes after thousands of doctors have taken part in a series of protests in recent months in the contract dispute. Talks broke down last year, and ministers have since said they will impose the new contract from next year. As the ballot papers went out a fortnight ago, Health Secretary Jeremy Hunt made a last ditch attempt to persuade doctors to accept the offer. He wrote to all the doctors in the country with a fresh offer. It included a promise of an 11% rise in basic pay, but the BMA said this was misleading as it was offset by curbs to other elements of the pay package, including unsociable hours payments.

Ministers have promised to protect pay for the first three years of the deal. But the BMA has said there are insufficient safeguards to stop hospitals overworking doctors and they could lose out financially in the long term. After the result of the ballot was announced, BMA leader Dr Mark Porter said: "We regret the inevitable disruption that this will cause but it is the government's adamant insistence on imposing a contract that is unsafe for patients in the future, and unfair for doctors now and in the future, that has brought us to this point. "Our message to him is that junior doctors have today made their views perfectly clear but that it is still possible to get back around the negotiating table to deliver a contract that is safe for patients, contains the necessary contractual safeguards to prevent junior doctors being overworked and properly recognises evening and weekend work."

Meanwhile, Labour shadow health secretary Heidi Alexander has written to the prime minister to ask him to intervene, saying the profession had "lost confidence" in Mr Hunt. She also wants to see independent arbitration. The letter - seen by the BBC - says: "With the NHS facing its most difficult winter in recent memory, and the prospect of industrial action now looming, it is imperative that urgent steps are taken to resolve this dispute." Roger Goss, of the campaign group Patient Concern, criticised the way both sides had handled the dispute but said doctors should not go on strike.

"This is the worst news for patients in the history of the NHS. What happened to the promise that the interests of patients are paramount and we put patients first? Any honourable doctor with a genuine vocation who wants to preserve the high esteem which the medical profession currently enjoys will refuse to cause suffering inherent in a full-scale walk-out."

Scotland and Wales have said they do not want to introduce the contract changes, while Northern Ireland has yet to make a decision.

Best thing is to enter into the talks and, when the inevitable dipsh!tting happens, re-ballot for another strike. And if that happens, don't fcuk about - do a proper, full-on walk out.

It gets better...

Hunt accuses BMA of using doctors' strike for political point scoring

I actually literally spat my coffee out when I saw that. Hunt has more brass neck than that Mao statue they've just dismantled.

The action comes at a time when the health service is already struggling to cope with patient demand across England, Wales and Scotland, leaving some facilities with more patients than beds.

Hunt said the government is now going through the “exhaustive process” of contacting every A&E department in the country to establish whether they will have enough staff to stay open on Tuesday.

Dame Sally Davies, the chief medical officer for England, told the Sunday Times she had sympathy with the junior doctors but wanted them to call off the strike. “Industrial action will lead to patients suffering, and no doctor wants to see that happen,” she said.

Dame Sally Davies, the chief medical officer for England, told the Sunday Times she had sympathy with the junior doctors but wanted them to call off the strike. “Industrial action will lead to patients suffering, and no doctor wants to see that happen,” she said.