The NHS could be facing its toughest winter ever. GP surgeries, social care services and NHS walk-in centres must open for longer to take pressure off casualty wards, leading emergency doctors have urged.

Dr Cliff Mann, the College of Emergency Medicine’s president, said: “There’s clear evidence from America and from the UK that if you have overcrowded emergency departments then the mortality rates for patients going through that department increases.”

Sir David Nicholson, the outgoing chief executive of NHS England, blamed hospitals’ financial problems and cuts to social care for the problems experienced by A&E units. Where local councils have cut social care particularly for the elderly, the A&E units have suffered as more elderly people are being admitted and then become trapped because they cannot be discharged.

For every hospital to provide a consultant-led A&E service for at least 16 hours a day everyday the NHS needs 2,000 A&E consultants but the NHS is currently 600 consultants short of this requirement. It has been identified that units are operating with just half the number of registrars that they needed to provide the service.

Currently there is a growing shortage of all levels of emergency medicine doctors. 50 per cent of emergency medicine training posts are still unfilled.  Dr Chris Moulton, vice president of the College said young doctors are discouraged by the high pressure and challenging working conditions on A&E wards.

The cost of locums last year was £120M. The College of Emergency Medicine wants the NHS to consider offering A&E doctors financial incentives, more time off, sabbaticals or earlier retirement in a bid to stop emergency medicine becoming unattractive to young doctors because of the routinely antisocial hours and intense pressure involved.

The medical director of the NHS, Sir Bruce Keogh, is set to publish a major report of emergency care in England with recommendations for long-term reform to services.