Emergency and urgent care will be prioritised over routine appointments and treatment during this week’s junior doctors’ strike, NHS England says.

The strike will begin early on Tuesday and run through until the early hours of Saturday, bringing “immense pressures” to staff and services, according to national medical director of NHS England Professor Sir Stephen Powis.

The health body said that appointments and operations will only be cancelled “where unavoidable”, following an estimate by the NHS Confederation that this could affect some 250,000 patients.

Professor Sir Stephen said: “The NHS has been preparing extensively for the next set of strikes but managing additional pressure doesn’t get easier as time goes by – it gets much more difficult, not only due to the sheer number of appointments that need to be rescheduled, but also that they can take time to rearrange with multiple teams involved.

“This is set to be the most disruptive industrial action in NHS history, and the strikes tomorrow will bring immense pressures, coming on the back of a challenged extended bank holiday weekend for staff and services.

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NHS braced as four-day strike looms

“Emergency, urgent and critical care will be prioritised but some patients will unfortunately have had their appointments postponed – if you haven’t, please do continue to come forward.”

The British Medical Association (BMA) wants the health secretary to negotiate to resolve 15 years of “pay erosion”, insisting that junior doctors have lost more than 25% of their pay in real terms.

More on Nhs

The organisation has said the strikes could be avoided if the government makes a “credible” pay offer.

But the Department for Health and Social Care wants the strikes cancelled before it will enter into negotiations.

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In an op-ed for The Sunday Telegraph, Health Secretary Steve Barclay described the BMA’s position as “unrealistic”, adding: “This demand is widely out of step with pay settlements in other parts of the public sector at a time of considerable economic pressure on our country.

“A salary hike of this size would see some junior doctors receiving more than an extra £20,000 a year,” he said.

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“I recognise their hard work and dedication.

“But it is deeply disappointing that this industrial action has been timed by the British Medical Association (BMA) junior doctors’ committee to cause maximum disruption to both patients and other NHS staff.”

Dr Mike Greenhalgh, deputy co-chair of the BMA’s Junior Doctors Committee, told BBC One’s Breakfast show: “If he was to bring a credible offer to us, it could still, even at this late stage, avert action.”