Junior doctors have been ordered to break their strike action and return to work in a hospital in the West Midlands after declaring a level 4 incident.
Sandwell Hospital in West Bromwich issued a statement on Tuesday morning saying it had received an unusually high number of patients over the last two days and had discharged fewer than normal.
But the British Medical Association, the doctors trade union, has told junior doctors to continue with industrial action until it has reached an agreement with NHS England that it is a "major unpredictable incident".
Thousands of junior doctors have joined pickets outside around 100 hospitals throughout England in the most significant strike by medical staff in 40 years.
The strike action - supported by two thirds of the public - started at 8am on Tuesday morning and could be followed by two further walk-outs.
The BMA said: "Junior doctors should continue with industrial action until NHS England has confirmed and the BMA has agreed – via the agreed escalation process – that a major unpredictable incident is taking place for a specific Trust.
"The BMA will notify members as soon as such an incident is tin place."
NHS England said it was reviewing the "exceptional" situation reported by Sandwell Hospital and working with the BMA to ensure patient safety.
In his statement ordering junior doctors back to work, Dr Roger Stedman, medical director at Sandwell and West Birmingham Hospitals NHS Trust, said: "Over the last two days we have had very high numbers of patients come to hospital, and fewer than usual discharged.
"Because of that we decided to require trainee doctors allocated to ward work to attend Sandwell during today's strike."
A poll for IPSOS Mori poll for the Health Service Journal found that 66 per cent of the public support junior doctors walking out from all but emergency care.
But support drops when strike action would also affect A&E and other emergency services - as is planned for next month - with only 44 per cent backing. But this is still higher than the 39 per cent who said they opposed such action.
A 48-hour walk out is planned for January 26 and 27 and a third strike is planned for February 10, when strike action will include all care.
Anne Rainsberry, national incident director for NHS England, said: "Sandwell Hospital has reported that it has been experiencing exceptional and sustained pressure.
"In line with the local agreement between the trust and the BMA, their medical director has asked junior doctors to return until such a time as the pressure is relieved.
"The local NHS is actively reviewing the situation to support the trust. Nationally, we are continuing to work closely with our BMA colleagues to ensure patient safety."
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