Junior doctors may keep striking for another year in their bitter pay dispute with the government, despite NHS leaders’ growing alarm about how the industrial action is disrupting patient care. Trainee medics in England could even hold a week-long stoppage to escalate their campaign of industrial action to secure a 35% pay rise from the health secretary, Steve Barclay. The prospect of prolonged and intensified stoppages by England’s 61,000 junior doctors comes as the NHS prepares for four days of hospitals being severely stretched by a strike that starts at 7am on Tuesday and will have the biggest impact of any strike in the service’s 75-year history. The enforced cancellation of up to 350,000 outpatient appointments and operations has led to a plea from hospital bosses for the conciliation service Acas to get involved to try to broker a deal to end the dispute, amid fears that patients will be put at risk as a direct result of the strike. Barclay and the British Medical Association (BMA) are at loggerheads over junior doctors’ demand for a pay rise of 35% to act as “full pay restoration” for the 26.2% loss in real-terms income they have experienced since 2008. Junior doctors are also disillusioned at the increasing inability of the overstretched health service, which has more than 130,000 staff vacancies, to provide fast and high-quality care to people in a medical emergency, for example at A&E or after calling 999. Sources at the BMA, the main doctors’ union, told the Guardian that junior doctors’ leaders were considering ramping up their industrial action to try to force the government to negotiate. “If there’s no movement, we’re looking at months and months of action. This could go all the way through to the next general election,” said one senior BMA source. A second BMA official said: “Escalation could be on the cards. There is enough motivation and resources for junior doctors to keep going for another year.” A third source at the union added: “The next set of strikes could be longer ones if Barclay doesn’t move. He has to be pressured to start making offers. I’m sure the juniors have got a five-day strike on their minds.” In deciding on their next steps, leaders of the BMA’s junior doctors committee (JDC) will have to weigh up how willing the medics they represent will be to lose five days’ pay if they do decide to call a strike lasting that long. Junior doctors held a three-day stoppage last month. The JDC will also have to take into account the readiness of their consultant colleagues – senior doctors – to cover for the juniors, including on overnight shifts, while they are refusing to work. The JDC has indicated its willingness to lower its 35% claim. It twice last week asked Barclay to make junior doctors “a credible offer” that would allow the JDC to call off this week’s action and start talks. However, the health secretary maintains that the 35% is a precondition to talks taking place that he is not prepared to meet – a claim the BMA disputes. Matthew Taylor, the chief executive of the NHS Confederation, suggested that Acas get involved to try to break the deadlock between Barclay and the BMA. The conciliation service could “provide some basis for negotiations, because – if anything – the position seems to have hardened over the last couple of days”. He also urged the public to avoid “risky behaviour” this week, to try to minimise the burden on hospitals that will be under even more strain than usual with their junior doctors absent. “It’s going to be an incredibly tough week,” Taylor said. “We’ve got four days of industrial action which, of course, come after the Easter bank holiday weekend, followed by another weekend, so you’re talking about 10 or 11 days when the NHS is not able to operate at full strength.” This week’s stoppage would have a “catastrophic impact” on the health service’s efforts to tackle the 7.2 million-strong backlog of patients waiting for hospital care, Taylor added. In a new advertising campaign launched today, the BMA claims that three junior doctors involved in the removal of someone’s appendix would be paid only £66.55 between them for their work. The campaign will ask: “Is this a fair price to provide patients with high quality healthcare?” Meanwhile, polling out today shows the number of Britons who support their campaign of strikes outnumbers those who oppose them by more than two to one, and is growing. The polling agency Ipsos found that 54% of the 1,092 adults questioned said they supported the strikes, 3% more than did so when asked last month. Just over a quarter (26%) of participants said they opposed the stoppages while the other 17% had no view either way. However, more of the public back the strikes by nurses (60%) and ambulance staff (60%) that were held in December, January and February. Those strikes were suspended in March, which led to health unions holding negotiations with Barclay and emerging with a pay deal for 2022-23 and this year that all but one of them, Unite, have recommended their members accept. Keiran Pedley, Ipsos’s head of research, said: “These findings reflect a consistent pattern over time whereby the public tend to be most likely to support strike action for professions that they hold a more positive view of.” There is stronger public support for strikes by junior doctors than railway workers (35%), civil servants (33%) or university staff (32%). In his latest criticism of the BMA, Barclay said that this week’s 96-hour stoppage had been deliberately timed to “maximise disruption” to NHS care at a time of year when many staff are on holiday, often to look after children while schools are shut for Easter. “It is extremely disappointing the BMA has called strike action for four consecutive days. Not only will the walkouts risk patient safety, but they have also been timed to maximise disruption after the Easter break,” he said. “I hoped to begin formal pay negotiations with the BMA last month but its demand for a 35% pay rise is unreasonable. It would result in some junior doctors receiving a pay rise of over £20,000. If the BMA is willing to move significantly from this position and cancel strikes we can resume confidential talks and find a way forward, as we have done with other unions.”