Good morning. The colder months are always more challenging for the NHS. More people get sick, there are fewer staff over the Christmas holiday period and many NHS services such as GP surgeries are shut, piling the pressure on A&Es and hospital wards. This year the annual crisis is coinciding with a junior doctor strike. The long-running dispute is already having a serious impact, with at least one A&E in Gloucestershire temporarily closing its doors. Patients have been warned of serious disruption, but NHS bosses have said that anyone with a health emergency should use the health service as normal. The British Medical Association (BMA), the union representing striking junior doctors, has said that the industrial action is a necessary part of protecting the profession. The goal, the BMA says, is not to “collapse” the NHS but to “save it”. The junior doctors, who make up nearly half of the medical workforce in the NHS, have been demanding a 35% pay rise that would address the 26.2% fall in the real-terms value of their salaries since 2008. The government has given them an uplift on average of 8% this year, with an additional 3% offer, which the BMA has said is not good enough. Rishi Sunak has implied that the demands from the BMA are unreasonable, saying that the doctors are “refusing to accept something that everyone else is now accepting”. For today’s newsletter, I spoke with the Guardian’s health policy editor, Denis Campbell, about the emerging tensions between different medical groups, the impact on patients and the chance of a pay deal happening anytime soon. That’s right after the headlines. Five big stories Israel-Gaza war | The US said “very serious” negotiations were taking place in Egypt on a new Gaza ceasefire and release of more Israeli hostages, but prospects for a deal remained uncertain as Hamas reportedly insisted it would not discuss anything less than a complete end to Israel’s offensive in the Palestinian territory. UK news | Two 16-year-olds have been found guilty of murdering Brianna Ghey, a “unique, and truly unforgettable” transgender girl who was stabbed 28 times in a Warrington park this year. Immigration and asylum | A total of 23 asylum seekers are thought to have killed themselves in Home Office accommodation between 2020 and so far in 2023, more than double the total in the previous four years, the Guardian has learned. Privacy | The police will be able to run facial recognition searches on a database containing images of Britain’s 50 million driving licence holders under a law change being quietly introduced by the government. Privacy campaigners have warned that the move, contained in a single clause in a new criminal justice bill, could put every driver in the country in a permanent police lineup. Covid inquiry | Boris Johnson’s Downing Street was so “macho and egotistical” that women’s voices were heard for as little as 10 minutes in five hours of meetings during a key week of coronavirus policy, the Covid inquiry has heard. In depth: ‘The timing of the strike is deliberately intended to inflict the maximum disruption’ Junior doctors include everyone from fresh-faced medical graduates in their early 20s all the way up to those who have a decade of experience in the health service. They are united in the effort to get more pay, however, Denis has reported on tensions that have started to emerge between junior doctors and consultants. “The view that I pick up increasingly among consultants is that they believe the offer put in front of junior doctors is not bad, in a year when the government’s been trying very hard to peg every group of public sector workers down as low as they can,” Denis says. The decision to hold out and wait for a better pay deal has begun to grate on more senior staff, partly because whenever junior doctors strike, consultants are the ones who have to cover for them. Over the course of his reporting, consultants have told Denis that they are already feeling worn out after a particularly difficult year in the health service, especially after covering what will be 28 days of strike action this year. This will be followed by another six days in early January, which will be the longest walkout in the NHS’s 75-year history. For the first time, a rift has started to emerge between groups that generally express solidarity with one another, indicating just how fraught the situation is getting. “They’re increasingly vocalising how fed up they are and are questioning what the gameplan for the junior doctors really is,’’ Denis adds. Will there be a resolution? The negotiations are now at an impasse. The government is refusing to get around the table with the BMA while there are junior doctors’ strikes planned. The union has shot back by criticising ministers for engaging in “unnecessary posturing”, adding that it is actually the government’s “dogma” that is delaying a resolution to the strikes. This stalemate means that the six-day strike in January is looking unavoidable. “One thing that might happen is, if the NHS visibly collapses between now and early January, the BMA could, as a benevolent gesture, say they will suspend the strike if the government agrees to talk to them again – though this is very unlikely,” Denis says. Impact on the health service December is always a brutal time for the NHS. But this year the health service winter crisis has been combined with junior doctors withholding labour for an extended period of time. Over the next three weeks, there will only be four weekdays that are not affected by strike action or holidays. “The timing of the strike is deliberately intended to inflict the maximum disruption,” Denis says. Some departments will scale back what they can offer or even close their doors entirely during the strikes. According to the NHS, wait times for hospital-based care will inevitably be longer, there will be an increased admin burden and there will be difficulties discharging patients in a timely manner. Not all services will be directly affected, however. The NHS intentionally winds down certain kinds of non-urgent treatment during the holiday period. “There are fewer outpatient appointments and fewer planned surgeries than usual, meaning that not many of these will have to be rearranged,” Denis says. Political response Though the Labour party has been more sympathetic to the striking doctors, they have not said that they would be willing to meet their demands. Instead, shadow health secretary Wes Streeting (pictured above) has said that raising the pay of junior doctors would be a “journey” not an “event”, which suggests that a future Labour government would “potentially seek to strike a multi-year deal that over time would hopefully meet the concerns from junior doctors about pay erosion. This is speculative but it is also a fair inference of what Streeting said,” Denis says. The BMA has already publicly said that junior doctors are prepared to keep striking up until the general election if required, which could happen as late as December 2024. “This time next year,” Denis warns, “the junior doctors’ strike could plausibly still be going on.” What else we’ve been reading In her latest Gaza diary, Ziad reveals how people are helping each other in extreme conditions, and taking care of the most vulnerable. Clare Longrigg, acting head of newsletters Sian Cain’s interview with the icon Natasha Lyonne (pictured above), star of the series Pokerface, is one of the best things I read this week. Nimo “For the few who can afford it, there is an elevator rather than a ladder up the ranks of citizenship.” Marco Deramo looks at the places where citizenship is for sale, and for whom. Clare The crisis at the US-Mexico border is only getting worse, campaigners and advocates say. Paulina Velasco reports from Jacumba Hot Springs and reveals the scale of the humanitarian disaster that is unfolding. Nimo Stuart Jeffreys talks to Ebon Moss-Bachrach, who plays Richie in The Bear, about grief, baking and how his chaotic character became the engine of the series. Clare Sport Football | After the stalemate, the slaughter. Liverpool channelled the frustration of being held by Manchester United into an emphatic 5-1 destruction of West Ham to book their place in the League Cup semi-finals for a record 19th time. Chess | Bodhana Sivanandan, a British schoolgirl who made chess history after she beat a master more than 30 years her senior at an international competition got into chess “accidentally”, her father has revealed. Paris 2024 | The head of the Paris Olympics has hit back at Sebastian Coe’s comments that tickets are too expensive by claiming they are cheaper than London 2012. Coe warned on Monday that the cost of attending athletics finals at next summer’s games could freeze out genuine fans. The front pages The Guardian’s headline is “Outrage over police access to 50m driving licences to run face checks” as the paper reports on a new law being introduced by the UK. Some of the other papers are looking at the convictions over the murder of Brianna Ghey. The Mirror has the headline “We will never stop loving her” while the Mail says “What they did to our beautiful Brianna will haunt us for ever”, as both papers cover the reaction of her parents. The i is covering inflation figures with the headline “Tax cuts in 2024 after surprise fall in inflation”. The Times has a similar theme with “Cheaper mortgages set to ease living costs”. The Financial Times headline is “Modi ‘ready to look into’ any evidence of assassination plot on American soil” as it says the PM has commented for the first time on allegations of an Indian plot in the US. In the Telegraph it’s “Sunak vows to defend Ulster veterans” as the paper covers a legal challenge to British law giving immunity to soldiers involved in the Troubles. And in the Sun the headline is “Bargain Hunt star’s attack charges”, as it says the programme’s star has been charged by police after a probe into domestic abuse allegations. Today in Focus The ‘cruel’ new visa rules set to break up families Government attempts to bear down on record migration figures will target family visas for those earning lower incomes. Hannah Moore speaks to social affairs correspondent, Robert Booth. Cartoon of the day | Ella Baron The Upside A bit of good news to remind you that the world’s not all bad They call it the anillo verde, the green ring, a 30km (19 mile) series of parks and cycle lanes that encircle Vitoria-Gasteiz, the capital of the Basque region in northern Spain, and a city centre that is largely car-free. This small Spanish city is an unlikely global leader in urban green policy. While many other cities around Europe were embracing cars in the 1970s, and in many cases building bigger roads and more capacity, they took the then fairly radical decision to buck the trend by starting to pedestrianise the city centre, and created Spain’s first network of cycle paths, which now extends to 180km, one of the most extensive in the country. Sign up here for a weekly roundup of The Upside, sent to you every Sunday Bored at work? And finally, the Guardian’s puzzles are here to keep you entertained throughout the day – with plenty more on the Guardian’s Puzzles app for iOS and Android. Until tomorrow. Quick crossword Cryptic crossword Wordiply