The NHS was put on a crisis footing tonight as hospitals in England were told to discharge as many patients as possible while estimated daily Omicron cases hit 200,000 and the variant claimed its first life in the UK. Amid a scramble for tests and booster jabs, the country’s doctors called for further restrictions to be imposed to stem the rise in cases and Downing Street did not rule out fresh measures. In a letter to hospitals, NHS England chiefs said patients who could be discharged to care homes, hospices, their own homes or hotels before Christmas to free up beds, should be. The letter from NHS England’s chief executive, Amanda Pritchard, and medical director Prof Stephen Powis said the service was facing a level 4 “national incident”. Hotels are already being turned into temporary care facilities staffed with workers flown in from Spain and Greece to relieve rising pressure on NHS hospital beds. Hospitals and GPs have also been told to scale back normal services and limit care to those needing urgent attention so that NHS staff can be freed up to deliver boosters. Hospitals will undertake fewer non-urgent operations, but “highest clinical priority patients”, including people with cancer and those who have been waiting a long time, will be given priority. They have also been told to take ambulance-borne patients into A&E more quickly so that paramedics can get back on the road to answer more 999 calls, speed up efforts to bring in nurses from overseas to help tackle the NHS’s lack of staff, and send as many patients as possible for surgery at private hospitals. A campaign to give boosters to more than 1 million people a day got under way, prompting the NHS website to crash and people to queue in the street for up to five hours for their jabs. But the British Medical Association said the vaccination campaign would not be enough to stop the spread of Omicron, with one in four still not eligible for a booster. They called for a return to face masks in pubs and restaurants, 2-metre social distancing indoors, limits on public gatherings, legal requirements for ventilation in schools and other settings, more rapid testing and advice to wear FFP2 masks. No 10 insisted that the booster campaign was its immediate priority, with a senior government source describing the main strategy as “keep on jabbing”. But Boris Johnson refused to rule out tougher restrictions if necessary to maintain public health. No 10 said all options were still on the table, leaving open the possibility of closing schools “as a last resort” and bringing in curbs without consulting MPs “in extremis”. Addressing MPs, Sajid Javid revealed there may now be as many 200,000 Omicron infections a day. He said around 20% of confirmed cases in England had been identified as the Omicron variant, and warned of “difficult weeks ahead”. In London, the centre of the Omicron outbreak, it accounted for over 44% of cases and was expected to become the dominant form within 48 hours, the health secretary said. He said Covid passports would be toughened to require people to have a booster or recent lateral flow test (LFT) in the new year, risking inflaming Tory backbench anger against restrictions ahead of Commons votes on “plan B” restrictions. Johnson is braced for his biggest rebellion as prime minister on Tuesday, with about 80 Tory MPs confirmed to be preparing to vote against measures on working from home, Covid passports and more mask wearing. He will have to rely on Labour votes for the votes to pass. Labour backed the government’s booster campaign and stopped short of calling for any new restrictions, with Keir Starmer saying it was Labour’s “patriotic duty” to vote for plan B. The prime minister confirmed the first death of a patient with Omicron and 10 people hospitalised with the variant, saying people needed to “set aside” the idea that the variant was mild. Meanwhile, head teachers warned of “chaos” in schools, with high levels of staff and pupil absences and reports that some parents were planning to keep children home to avoid the virus before Christmas. On the first day of the new vaccine campaign, 386,000 people in England are understood to have booked booster jabs – almost 50,000 an hour. But there was confusion over whether all eligible over-18s would be able to get a booster by the end of the year, with No 10 insisting they would, while the NHS cast doubt on the goal. Javid suggested the target was to “offer” rather than deliver the boosters. It is understood No 10 will also launch a new effort to reach the unvaccinated, using a publicity campaign potentially involving faith leaders and celebrities. On Monday people trying to get LFTs were told they were unavailable despite a new requirement for Covid contacts to take them daily for a week. The call from the BMA for tougher restrictions echoed warnings from scientists that vaccination alone would not be able to stop Omicron causing a dangerous second wave. Leaked documents from the UK Health and Security Agency showed on Friday that public health officials believe there should be “stringent national measures” by 18 December at the latest, with sources saying plan B will not be enough. The BMA, which represents 150,000 doctors, is the first major medical organisation to call for stricter measures. Dr Chaand Nagpaul, BMA council chair, said: “Despite describing the current situation as an ‘emergency’ with a ‘tidal wave’ of infections on the horizon, the government’s response, relying entirely on the vaccine booster programme, is missing the wider measures required to control the spread of Omicron, including protecting millions of people who will not be eligible for the booster programme by the end of December.” Chris Hopson, the NHS Providers chief executive, said the new guidance “gives an indication of what a monumental effort this will be”. No 10 has been resistant to new measures before Christmas but is planning to review the situation on 18 December.