Junior doctors walked out at 8am this morning at Sunderland in the latest round of strikes over contracts.
Between 8am and 5pm today and tomorrow, the doctors at Sunderland Royal Hospital will join their colleagues across the country, who will be out on strike in protest over new contracts.
This is the first all-out strike in the history of the NHS with junior doctors withdrawing emergency cover.
A spokesman for City Hospitals NHS Foundation Trust, said: "We have been working hard to try and minimise disruption during these periods and although we will be providing a full urgent and emergency care service we have had to cancel and reschedule a number of non-urgent operations and outpatient appointments. We would like to apologise for any inconvenience this has caused.
"All patients affected by any cancellations should by now have been contacted by the trust.
"Patients in need of urgent and emergency care during this period will continue to receive the treatment they need.
"However, those in less urgent need of care may experience longer waiting times than normal, including in our emergency departments at Sunderland Royal Hospital and Sunderland Eye Infirmary.
"As always, we are urging people to help us manage demand, and use emergency services wisely; and where appropriate to consider other healthcare alternatives to A&E such as visiting their pharmacist or GP, calling NHS 111, or visiting one of the Urgent Care Centres around the city."