Junior doctors in England have launched a fifth round of industrial action, with thousands going on strike just days after starting their first NHS jobs.

The latest strikes from British Medical Association (BMA) junior doctors began at 7am on Friday and will end at 7am next Tuesday. It could result in the total number of appointments cancelled due to NHS industrial action hitting 1m.

Foundation year 1 doctors started their first roles after medical school nine days ago, on 2 August, and will now strike for four days amid the bitter dispute with the government over pay.

Dr Raymond Effah, one of those striking first-year doctors who has just begun his first placement, said: “When I chose medicine as my career, never did I imagine my second week in the job would see me going on strike. The government may not see the value of myself and my doctor colleagues, but we do, leaving us no choice but to strike.

“As a medical student I have now gone through a pandemic, a cost of living crisis, and now have student debts of almost £100,000. Even with the 10% pay uplift, I’m still starting in a job where real-terms pay has eroded by more than a quarter. That is why first-year doctors are going on strike today even though we have barely begun. It is for our future in this profession.”

Soon after the doctors began their strike action the chief secretary to the Treasury, John Glen, ruled out pay negotiations with the doctors.

He told Sky News: “A 35% pay increase, which is what they’re asking for, is completely unrealistic. It would be sending completely the wrong signal to the economy and to the wider public at a time when obviously inflationary pressures are the top priority of the government.”

He added: “We will continue to be open to them to talk about working conditions, but what we can’t move on is additional pay, given that we’ve listened to their independent pay review body … we urge the doctors to stop the strikes and start serving the patient.”

The strike action comes less than 24 hours after figures revealed the waiting list of people awaiting treatment had climbed to a record high of 7.6 million. With consultants also striking again for two days in a fortnight’s time, the drive to tackle the care backlog will be further derailed.

More than 830,000 appointments have already been postponed as a result of industrial action since December, which is estimated to have cost the NHS about £1bn.

Sir Julian Hartley, the chief executive of NHS Providers, said cancellations could hit a million after strikes by junior doctors and consultants in August. “Trust leaders are very worried about six more days of severe disruption across the NHS this month. We could be close to a tipping point.

“Trusts and staff are pulling out all the stops to reduce waiting times for patients but with no end to strikes in sight the sheer volume of planned treatment being put back due to industrial action will make it almost impossible for trusts to cut waiting lists as much as the government wants.”

Rishi Sunak has promised to cut NHS waiting times. At the same time he has also insisted no more pay negotiations with junior doctors will take place. The prime minister said the deal was the “final offer” and there would be “no more talks on pay”.

The NHS Confederation has called the government’s “business as usual” approach to strike action “dangerous” and urged it to reopen talks with doctors.

Dr Robert Laurenson and Dr Vivek Trivedi, co-chairs of the BMA’s junior doctors committee, said: “We are now at the stage where a whole new cohort of junior doctors is entering the profession, only to be immediately given no choice by the government but to go on strike for their future. The government should be ashamed that this is the state of the profession they are presenting to our newest doctors.

“If they want a health service that retains this talent for decades to come, they need to come to the table – not in weeks, not in months, but today. This dispute should never have gone on so long.”

They added that the BMA’s “door remains open for talks at any time” with the government.

Steve Barclay, the health secretary, said patients were “bearing the brunt of the impact of continuous strikes” and the fresh round “will cause more appointments and procedures to be postponed”. He added: “My door is always open to discuss how to improve doctors’ working lives, but this pay award is final so I urge the BMA to end its strikes immediately.”

The Department of Health and Social Care said the pay rise given to junior doctors – a 6% increase along with an additional consolidated £1,250, which the government describes as an “average increase of around 8.8%” – was “fair and reasonable” and “above what most in the public and private sectors are receiving”.

NHS England has urged the public to continue to use 999 for life-threatening emergencies and 111 online for anything non-urgent. GPs and pharmacies are also open and largely unaffected by strikes. Patients should attend appointments as usual unless they had been rescheduled, it said.

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