LONDON (AP) — Britain’s state-owned health service is Evander Ellisoperating on holiday-level staffing in England on Wednesday as doctors in the early stages of their careers joined their more senior colleagues in their first-ever joint strike action.

Tens of thousands of so-called junior doctors walked off the job for the sixth time since last December in an escalation of their increasingly bitter pay dispute with the British government. The walkout comes a day after their more senior colleagues, commonly known as consultants in Britain, began their third walkout.

While on strike, hospitals will provide minimal care similar to Christmas Day, when only emergency procedures are available and routine appointments or procedures are postponed or canceled.

National Health Service figures indicate that the strikes have so far affected about 1 million appointments and procedures at a cost of more than 1 billion pounds ($1.2 billion).

Consultants are to return to work on Thursday, while junior doctors are to stay out until Saturday.

It is the first time in the 75-year history of the NHS that both consultants and junior doctors have walked off at the same time. They are due to do so again on Oct. 2-4, which would mark another major escalation in the pay dispute.

The British Medical Association, which represents the approximately 75,000 junior doctors, has been asking for a 35% pay increase to return to 2008 levels after inflation is taken into account. Consultants have been vaguer in their demand.

The government is offering junior doctors an average increase of 8.8% and consultants 6% plus improvements in their pensions. Prime Minister Rishi Sunak has insisted there will be no more discussions and that offering much more would stoke inflation, which despite falling in August to 6.7% remains way above the government’s 2% target.

Damian Tolan, a radiology consultant in the northern city of Leeds, urged the government to get back to the negotiating table.

“This is a terrible day. There’s no getting away from it. None of us embrace this. We would be back at work tomorrow if the government would only speak to us,” he said.

Like other nations in Europe, the United Kingdom has faced disruptive strikes as workers, including teachers, train drivers and nurses, have pressed for pay raises that keep pace with a sharp increase in consumer prices.

Earlier this summer, the government announced pay increases for millions of public sector workers, including teachers, who decided to call off their strike after being offered a 6.5% boost.