Health leaders have urged doctors and the Government to do 'whatever it takes' to ensure next week's strikes do not go ahead.

Junior doctors and consultants are due to walk out together for the first time on Wednesday in what has been described as a 'step too far' and a 'nightmare scenario' for patients.

The heads of England's ten largest teaching and research hospitals have written to the British Medical Association and the Prime Minister to express their 'profound concerns'.

They warned that each escalation 'tests the limits' of what the NHS can manage safely and added: 'Inevitably there will come a point where that limit is exceeded.' They stressed that while previous strikes had primarily impacted on elective care, leading to the cancellation of almost a million appointments, further action also risked hampering their ability to 'maintain safe emergency services'.

The cost of managing the walkouts – believed to be £1billion so far – was 'having a material impact on the resources available for improving care for the future', they added.

In July, the Government said junior doctors would get pay rises of 6 per cent, along with a £1,250 increase, and hospital consultants will also receive 6 per cent. Health Secretary Steve Barclay has described the deal as 'final' and refused to enter further negotiations.

Seven of the ten trusts who wrote to the PM paid consultants £269 an hour to cover night shifts for striking junior doctors in August, the Health Service Journal reported.