Leading emergency doctors have expressed alarm over serious staffing problems at two A&E departments, which have seen one being forced to shut its doors to emergency patients.
The Royal College of Emergency Medicine (RCEM) commented after NHS documents published by The Guardian claimed some doctors at North Middlesex Hospital's A&E lacked basic skills and junior doctors were asked to perform tasks they were not trained for.
As a result, health regulators have threatened to remove junior doctors from the London hospital's emergency department - which would throw the A&E unit into turmoil as it is already lacking sufficient numbers of middle-level and consultant emergency medics.
Meanwhile, Chorley Hospital in Lancashire, has been forced to temporarily downgrade it's A&E to an urgent care centre because it does not have enough medics.
At North Middlesex, the General Medical Council (GMC), has issued preliminary warnings to hospital leaders because of a lack of training for doctors.
Following a report by Health Education England, the NHS's staffing agency, which highlighted serious issues about the training for junior medics, the GMC issued a pre-statutory notice to the hospital "for the withdrawal of approval for the trainees in the emergency department".
Niall Dickson, the GMC's chief executive, told The Guardian: "We are extremely concerned about the standards of training and support for trainee doctors in the emergency department of this hospital.
"Without adequate support and supervision there is a serious risk that their patients are being put at risk.
"Ultimately we will not allow postgraduate training to continue in this department if the appropriate action is not taken."
In a statement, North Middlesex Hospital NHS Trust said: "Our trust accepts that we are facing a number of issues in our A&E department, particularly around medical staffing.
"We are working hard with our NHS partners to address these issues and, in particular, to recruit additional middle grade and consultant A&E doctors. We are looking at a number of short-term and longer-term initiatives to resolve the staffing issues and to relieve pressure on the A&E.
"We will continue to work with all our partners to make sure we are doing everything we can to meet the GMC's training requirements by the end of the month."
Meanwhile, in April Lancashire Teaching Hospitals NHS Foundation Trust was forced to temporarily downgrade Chorley Hospital to an urgent care unit because it does not have enough doctors.
The hospital said that continuing to provide a service without enough doctors would be "negligent" and put patients at "unacceptable risk".
Commenting on the situation at the two hospitals, Dr Clifford Mann, president of the RCEM, said: "Exhorting trusts to do better doesn't create more emergency medicine doctors. There are no quick solutions. To recruit and retain more emergency doctors, advanced clinical practitioners and emergency nurse practitioners will require hospitals to be paid for the acute care of ill patients - not financially penalised.
"The default solution of closure and merger of A&Es is destabilising those that remain. In the case of Chorley it is Wigan hospital that has been most affected. In London, if the North Middlesex were to close the implications for surrounding trusts would be overwhelming.
"Fully funding emergency care is the only way to ensure frontline resources are available to all patients with acute health care needs. The current funding model is neither efficient nor effective. Current staffing is neither adequate nor sustainable. Current expectations of A&E departments are undeliverable."