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which are demonstrating a real change in the approach from central nhs management, which we think is a misuse of the process. nhs england said strong evidence was provided when the most challenged systems needed support and it was expected local health managers would ask colleagues for allowances to be made to ensure safe cover. the row comes at a time of mounting pressure on health services in england, with some organisations declaring critical incidents or warning they were very busy with long waits in a&e. this is not unusual in mid winter, but the doctors walk out as to the usual challenges faced by hospital bosses. with the strike moving into a second day, there seems little prospect of talks between ministers and the bma before the action is over on tuesday. that means some more anxious days for hospitals and their patients. hugh pym, bbc news.

Central nhs managementNorthern englandHealth servicesHealth managersHospital bossesMid winterA eBbc newsBma unionHugh pym