Thousands of NHS workers, including nurses, midwives and ambulance staff, have begun a four-hour strike.
Workers from six trade unions are taking part, which will disrupt some NHS services - although urgent and emergency care will be unaffected.
The action - from 07:00 to 11:00 BST - mainly affects England, while some staff in Northern Ireland are involved.
Trade unions want a 1% pay rise for all NHS staff, but the government has said the proposal would cost too much.
Ahead of the strike, England's chief nursing officer Jane Cummings said "robust plans" had been put in place and patient safety "was a priority".
Military personnel and police have been put on stand-by to help ambulance services if needed.
As the morning has progressed, reports have emerged of ambulance services developing backlogs - although bosses say the life-threatening cases are being prioritised.
| Union | Staff groups | Number of members |
|---|---|---|
|
Unison |
Nurses, healthcare assistants, ambulance staff, porters and admin |
250,000 in England |
|
GMB |
Nurses, healthcare assistants, ambulance staff, porters, admin workers and cleaners |
22,000 in England and Northern Ireland |
|
Unite |
Nurses, healthcare assistants, ambulance staff, porters and admin |
92,000 in England and Northern Ireland |
|
Royal College of Midwives |
Midwives |
22,000 in England |
|
UCATT |
Maintenance staff |
480 in England |
|
British Association of Occupational Therapists |
Occupational therapists |
24,000 |
Meanwhile, hospital staff have been seen leaving the picket lines to deal with patients in places.
Union leaders have always said their members will be providing "life and limb" cover during the strike.
The expectation was that 999 calls would be answered and A&E units would remain open and that seems to have been the case, according to early reports.
However, hospital outpatient appointments, community clinics and some routine operations seem to have been affected.
The Royal College of Midwives, which is taking action for the first time in its history, has said services for women giving birth will be unaffected. Instead, its members are targeting antenatal and postnatal care.
Doctors and dentists are not involved.
Pay disputeUnison said the action - the first strike by NHS staff over pay in more than 30 years - would send a "clear message" to the government.
The walkout will be followed by four days of working to rule from Tuesday.
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Health Secretary Jeremy Hunt says a 1% pay rise for all NHS staff, in addition to increments, would lead to job losses
As well as the RCM, there are another five unions involved in the strike in England - Unison, Unite, GMB, UCATT and the British Association of Occupational Therapists. Between them they have about 400,000 members, including porters, cleaners and administration staff.
In Northern Ireland, members of Unite and the GMB are involved.
'Fairer deal'Ministers in England have awarded NHS staff a 1% increase, but only for those without automatic progression-in-the-job rises.
These, designed to reward professional development, are given to about half of staff, and are worth 3% a year on average.
An independent pay review board had said the 1% increase should be across the board.
It was implemented in full in Scotland. Northern Ireland has yet to make a decision on pay, while Wales did the same as England but did give extra to the lowest paid. Some unions are balloting their Welsh members about action there.
From the picket line: Dominic Hughes, BBC NewsA boisterous, noisy picket outside the Victorian facade of the old Manchester Royal infirmary has been made up of nursing assistants, porters, paramedics and for the first time in their history midwives.
Plenty of cars are tooting their support as they pass on Manchester's busy Oxford Road.
Inside the hospital some services will be affected, and a number of midwives have already left the picket to go to staff a ward that was short on numbers.
So this is a symbolic strike but one that displays the real anger of health workers over pay.
Health Secretary Jeremy Hunt said that hospitals would be forced to lay off staff if the recommended pay award was met in full.
"We have had very clear analysis that if we did that, hospital chief executives would lay off around 4,000 nurses this year and around 10,000 nurses next year," he said.
"The NHS has just come through a terrible tragedy with Mid Staffordshire when we discovered the most appalling care happening there and indeed some other hospitals as well.
"We have turned the corner on that by recruiting in hospital wards around 5,000 extra nurses in the last year alone. We don't want to turn the clock back on that."
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Workers in Newcastle, London and Manchester voice their support for the strike
Christina McAnea, head of health at Unison, said the offer in England was a "disgrace".
"The fact that so many unions representing a range of NHS workers are taking action or preparing to join future actions should send a clear message to the government," she said.
"The NHS relies on the good will of its workers, but we know that a demotivated workforce is bad for patients. The government needs to start negotiating with us and reconsider their pay policy."
RCM chief executive Cathy Warwick added: "At a time when MPs are set for a 10% pay hike, we're told that midwives don't deserve even a below-inflation 1% rise. And politicians wonder why the public does not afford them more respect.
"It feels to a great many people, including midwives, that there is one rule for them and another rule for everybody else."
Do you plan to take part in the NHS staff strike? Are you a patient that is concerned about the impact of strike action on NHS services? Send us your experiences by emailing haveyoursay@bbc.co.uk
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