A “second spike” in cyber-attacks has not hit the NHS but some hospital trusts are suffering ongoing disruption due to Friday’s ransomware virus.

Routine surgery and GP appointments have been cancelled across the NHS as it recovers from the global outbreak.

Patients have been urged to use the NHS “wisely” as the full impact of the ransomware attack comes to light.

Health Secretary Jeremy Hunt says it is “encouraging” there have not been any fresh attacks.

“We’ve not seen a second wave of attacks and the level of criminal activity is at the lower end of the range that we had anticipated,” he said.

Mr Hunt is expected to attend a Cobra committee meeting on cyber-security, chaired by Home Secretary Amber Rudd later.

‘Largest attack’

Eleven trusts out of 47 that were hit are still facing issues, leading to further cancellations and delays to services.

Patients have been told to turn up for appointments, unless advised otherwise, although some GPs are asking people to consider whether they really need to attend the surgery imminently.

The virus that hit the NHS in England and Scotland, known as Wanna Decryptor or WannaCry, has infected 200,000 machines in 150 countries since Friday.

The National Crime Agency said it has not seen a “second spike” in attacks but “that doesn’t mean there won’t be one”.

How is the UK’s biggest NHS trust coping?

Barts Health NHS Trust, which runs five hospitals in east London, says it continues to experience some “delays and disruption” to services.

It says it has “reduced the volume” of planned services for Monday and Tuesday, which means some surgery and outpatient appointments will be cancelled.

However, its hospitals remain open for emergency care and it is no longer diverting ambulances from its sites.

The trust said its trauma and stroke care services are now fully operational, as are renal dialysis services.

More on the latest NHS disruptions

Europol, the EU’s law enforcement agency, has called the cyber-attack the “largest ransomware attack observed in history”.

The ransomware, which locks users’ files and demands a $300 (£230) payment to allow access, spread to organisations including FedEx, Renault and the Russian interior ministry.

In England, 47 NHS trusts reported problems at hospitals and 13 NHS organisations in Scotland were affected.

NHS Wales said none of its computer systems was affected and no patient data compromised, while police in Northern Ireland said no incidents had been reported.

Some hospitals were forced to cancel treatments and appointments, and divert ambulances to other sites.