The NHS in England will need up to 10,000 additional hospital beds to keep patients safe this winter, an analysis suggested.
The British Medical Association (BMA) warned that over 300,000 patients could be left waiting on hospital trolleys in emergency care departments for more than 4 hours before being admitted.
"This winter could be the worst on record for frontline emergency care departments," said Dr Rob Harwood, BMA consultant committee chair.
The Department of Health and Social Care said it had given the NHS £1.6 billion this year to improve performance, as well as £420 million in additional winter support.
Analysis of NHS England Figures
The new figures build on a recent analysis by the doctors' union, released earlier this month, of NHS England data.
Guidance from the National Audit Office suggested that bed occupancy should not exceed 85% to avoid impacting on the quality of care, while NHS Improvement has said that deterioration in emergency care standards would be seen with an occupancy above 92%.
The analysis showed that bed occupancy averaged 94.9% during January 2018, rising to a peak of 95.1% in February. Those figures were responsible for 200,000 more patients being left on hospital trolleys in emergency care departments than in the same period in 2011.
By analysing bed occupancy rates and trends from previous winters, the BMA has predicted the number of extra beds required for January to March 2019.
It said hospitals in busy areas would see the greatest need, with London requiring as many as 900 extra beds this winter.
The BMA warned that between 918,000 and 1,021,000 people faced waiting more than 4 hours at major A&E departments in January to March 2019, compared with 860,000 during the same 3 months of 2018 which recorded the worst figures on record for the NHS.
It said the percentage of patients seen, admitted or discharged within 4 hours at all A&Es could slip from 85.0% to between 82.5% and 84.3% over the same time frame. The Government target was 95%, it said.
Hospital Bed Shortages
"A key part of this problem is the lack of available beds within the NHS system," Dr Harwood said. "Last winter saw incredibly high levels of bed occupancy, well above recommended limits, and despite thousands of escalation beds being put into action temporarily. At this level patients will struggle to get the attention and care they need.
"The uncertainty being caused by Brexit, especially the future of thousands of EU doctors working in the NHS, is only exacerbating concerns about the level of care the NHS can deliver.
"While there is a commitment for the NHS Ten Year plan funding to come on stream next April, there is a pressing need to tackle shortages in hospital capacity and improve care for patients in the community. The BMA believes that, at the very least, the NHS in England needs 10,000 hospital beds to meet the rising levels of pressure that we are predicting will come to bear on the NHS this winter."
Extra Winter Funding: DHSC
A Department of Health and Social Care spokesperson said: "Despite an extra 840,000 people going to A&E, hardworking NHS staff have seen nearly half a million more people within 4 hours over the last 12 months than compared to last year.
"We have given the NHS £1.6 billion this year to improve performance and cut waiting times, as well as £420 million in additional winter support to redevelop A&Es, improve emergency care and help patients get home quicker.
"Our long-term plan for the NHS, backed by an extra £20.5 billion a year by 2023-24, will improve front-line services and put our health service on a sustainable footing for years to come."
The Department said it had other plans to support the NHS over the winter period, including "an ambition" to reduce stays in hospital of over 21 days by 25% in order to free up 4000 beds.
