The NHS will be “looking into the abyss” if hospital consultants follow the example of junior doctors and go on strike over pay, the leader of England’s hospital bosses has said. Hospitals will be left unable to function normally if consultants – the most senior doctors on wards – stage walkouts in pursuit of their pay claim, Sir Julian Hartley said. “If consultants withdraw their labour, as junior doctors are doing again this week, that would be unthinkable without considerable derogations,” said the chief executive of NHS Providers. “It would be incredibly difficult to run a hospital and other critical services.” Hospitals have already had to postpone more than 500,000 outpatient appointments and operations as a result of the recent industrial unrest by nurses, junior doctors, ambulance workers and other staff. With junior doctors threatening to continue striking until next March, NHS chiefs are alarmed that consultants will add to the chaos engulfing the service by taking action too. The British Medical Association (BMA) is balloting consultants about whether they are prepared to go on strike to try to force ministers to restore the 35% fall in the value of their salaries since 2008. Consultants are threatening to join the wave of strikes that has hit NHS care since December over what they say are years of real-terms pay cuts. The ballot closes on 27 June and the result is expected soon after. If enough consultants back strikes to ensure that any action is legal, they will refuse to work on 20 and 21 July and reduce the NHS to a Christmas Day-style service on those days. While emergency care such as as A&E would continue, most planned work – outpatient appointments and surgery – would be called off. Junior doctors are in the final hours of their third significant strike since March, which have lasted for 72, 96 and 72 hours respectively. They remain at loggerheads with the health secretary, Steve Barclay. The strike, which ends at 7am on Saturday, is estimated to have led to another 150,000 appointments being axed. NHS care could also be disrupted until the end of the year by another series of strikes by nurses. The Royal College of Nursing (RCN) is separately balloting its 300,000 members in England as to their willingness to renew their campaign of industrial action, which began before Christmas. Nurses went on strike three times before calling off their campaign and holding peace talks with Barclay. Those talks broke down, however, and the RCN narrowly rejected a pay deal that many other unions accepted and then began seeking a second legal strike mandate. NHS leaders are contemplating a scenario in which junior doctors, consultants and nurses could take action in quick succession, potentially disrupting hospital services for a week at a time. The BMA’s junior doctors committee (JDC) this week said that “an indefinite withdrawal of labour” was inevitable unless Rishi Sunak and Barclay came up with a better offer than the 5% uplift they had proposed. Hartley said the NHS would not cope if consultants and junior doctors decided to strike on the same days. He said: “That’s looking into the abyss. I don’t know how we could function as an NHS in that scenario, with no derogations. But let’s hope we never get to that prospect.” The BMA has ruled out consultants and junior doctors striking simultaneously. But it has pointed out that the two sets of doctors could stage stoppages on consecutive days, to maximise disruption. Hartley said: “No one should underestimate how challenging the two-day strike proposed by senior doctors in July could be for the NHS. The planning for cover and services needed is uncharted territory for the health service.” Hospital bosses are “incredibly frustrated” that strikes could go on for many months yet. The government shows no signs of agreeing to the junior doctors’ 35% claim, which it describes as “unreasonable”, while the BMA insists juniors deserve that rise. Hartley said unending strikes were also dangerous for the health service because “patients are losing faith in the NHS to deliver for them” as a result of so many having their appointments with specialists or operations cancelled. He said public satisfaction with the service, already at its lowest level, could fall further unless ministers and the BMA resolved their differences and banish “the continual black cloud of disruption”. Hartley, who said he understood why junior doctors wanted better pay, also said patients were being left upset, in pain, discomfort and anguish when their hip or knee replacement was rescheduled because junior doctors were on strike. He pointed out that each junior doctors’ strike was costing large NHS trusts up to £2.5m because they had to hire locums and pay consultants to cover junior doctors’ shifts. He said hospital bosses felt as if they were letting patients down when they cancelled appointments that fell on strike days. Responding to Hartley’s remarks, Dr Robert Laurenson and Dr Vivek Trivedi, co-chairs of the JDC, said: “These strikes are disruptive and expensive, so it would be far more cost-effective for hospitals and the NHS in the long run – not just on strike days – for the government to end this dispute by paying doctors what they are worth. “This would help keep doctors in the NHS, reduce rota gaps and end the reliance on expensive agencies. The government must step up to the plate. “Consultants have seen an even deeper pay erosion than junior doctors, with their pay declining by 35% in the last 15 years. We have seen extraordinary support from our consultant colleagues during this action, and if they decide to strike as well, that support will be repaid by juniors. What is ‘unthinkable’ is for government to continue cutting the pay of doctors and expecting the NHS to recover from its current prone state.” Dr Mike Henley, the BMA consultants’ committee deputy chair, said: “Like junior doctors, consultants have been driven to balloting for industrial action by long-term government refusal to address a devastating erosion in their pay over the last 15 years. “Senior and junior doctors are united in our frustration with a government that refuses to come to the table with reasonable terms and refuses to repair the broken pay review process that was meant to avoid this very situation.” The Department of Health and Social Care has been approached for comment.