Practices were overwhelmed yesterday as they faced pressure to keep patients out of hospitals amid the “collapse” of services.

Hospitals resorted to extreme measures to release beds and manage patients as the “unprecedented” winter surge of illness continued. Growing numbers of NHS trusts declared critical incidents while in West Yorkshire the Integrated Care Board messaged practices asking them to concentrate on the care of the most seriously ill patients. It said they should “step down” routine and non-urgent activity – and also ensure they saw patients before sending them to hospital. It said that local hospitals were rescheduling all but the most urgent care.

The Royal Cornwall Hospitals NHS Trust advised visitors to the county to bring first aid kits, including pain relief and rehydration powders. In Portsmouth the hospital issued an appeal to relatives to come and take patients home. A statement from Portsmouth Hospitals University NHS Trust said: “Demand for emergency and urgent care is far outstripping the capacity available in Portsmouth and South-East Hampshire.” Its medical director Dr John Knighton told the public: “As soon as a person is medically ready to leave hospital, they should be discharged to their place of residence. Every time one patient leaves hospital it helps a further four patients move through the hospital to ensure they get the care they need in a timely way.”

Doctors continued to use social media to describe their experience of the “collapse” of services. Emergency medicine specialist Dr Maud McCutcheon, from Bristol, tweeted: “That was possibly the shift that’s given me the most moral injury in my career so that’s fun. The NHS is in crisis, people are dying that may otherwise be saved.”

The leading geriatrician Professor David Oliver tweeted: “In nearly 34 years in the job and 25 as a consultant, when I am working on deeper wards beyond the AMU/ED/SDEC, I have never seen an inpatient case mix this complex in terms of frailty, multiple long term conditions, acuity, functional/cognitive impairment, psychosocial issues.”

One prominent GP academic, Professor Kamlesh Khunti, of Leicester University, used the hashtag #GPunsustainable as he tweeted: “Crazy morning on call in GP practice today. Started 8am. Been non-stop five hours so far.”

Outspoken Surrey GP Dr Dave Triska stated: “NHS is collapsing no more. Collapsed. The public now being asked to drag people out of hospital beds and care for them at home. It’s happened in plain sight. Not a peep from the government.”

Essex GP Dr Mike Smith stated: “Seriously impressed with my admin team yesterday at work after such a busy day, the abuse they had to deal endure from some patients would shock most normal people. I can’t think why people think it’s acceptable to speak to people in this way.”

NHS England chief executive Amanda Pritchard said in a Christmas message: “I always thought that, difficult as those initial waves of COVID were, and they really were, actually it would be dealing with the ongoing pressures, that could be even tougher – that combination of recovering services whilst also dealing with continuing COVID and everything else that winter throws at us. We’re facing record demand for many services from GP services to mental health services and of course, urgent and emergency care. But despite these pressures, NHS staff are rising to the challenge every single day.”