This is what Prof Chris Whitty, the government’s chief medical adviser and the chief medical officer for England, told the RCGP conference as he explained why the winter would be “exceptionally difficult” for the NHS.

He said this would be the case even without a major Covid spike. He explained:

The winter as a whole, I regret to say, is going to be exceptionally difficult for the NHS and general practice is going to be absolutely at the forefront of this, unfortunately.

That is irrespective of whether we have a relatively low but non trivial amount of Covid, or whether we actually have a further surge in the winter.

If you ask 100 modellers, you’re going to get over 100 answers exactly as to how this is going to go out. I think what we’re confident of is the very top end that we would have faced, potentially if things had gone wrong [like] last winter, is not going to happen, barring an extraordinary escape variant ...

I think the top end risks are much lower, but we could certainly go up. We are only two to three doubling times away from really quite serious pressure on the NHS - it’s already serious but one that would be very difficult to deal with.

So, the margin of error is quite small.

Zero Covid over this winter is a completely impossible dream ... What we hope is we can keep it roughly to low levels.

But we’ve got flu resurging. There’s a lot of debate about whether we’ll have a low flu year, because a lot of people are actually meeting many fewer people than they did two years ago. Maybe that’ll hold the line. On the other hand, we have less natural immunity in the system, we could have a really serious spike, and we could have a flu vaccine that is not very well matched to the flu we get because there hasn’t been enough flu circulating in the southern hemisphere really to get a proper fix on this.

We’ve definitely got some quite serious other respiratory infections going around. And we have all the usual winter pressures on cardiovascular, slips and trips, and everything else that goes with it.

So if you layer all of that on top of one another, and then you add on the fact there’s no doubt that we’re now seeing, as we knew from the beginning would happen, people who delayed coming to see doctors coming at a later stage of their disease, and therefore more seriously ill, and the fact that we’ve got to catch up on things like screening, and we’ve got to maintain the vaccination momentum - that’s an extraordinarily tall order when you add all of those up.

I wish I could claim the sunlit uplands and it’ll all be fantastic by Christmas but, sadly, I’m afraid [that’s not the case]. But we are in a so much better place than we were before.

Chris Whitty speaking at the RCGP conference this morning.
Chris Whitty speaking at the RCGP conference this morning. Photograph: RCGP