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The head of NHS England has warned that July's planned strikes in the health service could be the worst yet for patients.
Amanda Pritchard said industrial action across the NHS had already caused "significant" disruption - and that patients were paying the price.
This month's consultant strike will bring a "different level of challenge" than previous strikes, she said.
Junior doctors and consultants will strike for a combined seven days.
Ms Pritchard told the BBC's Sunday with Laura Kuenssberg programme that the work of consultants - who are striking for the first time in a decade - cannot be covered "in the same way" as junior doctors.
"The hard truth is that it is patients that are paying the price for the fact that all sides have not yet managed to reach a resolution," she said.
Last month, junior doctors in England voted for five days of strikes in mid-July - their longest strike yet.
They will walk out between Thursday 13 July and Tuesday 18 July after rejecting a government pay offer.
A few days after that strike ends, on 20 and 21 July, hospital consultants in England will strike over pay.
Negotiators for consultants and junior doctors have been asking for a 35% pay increase to make up for what they say are 15 years of below-inflation rises - a figure Health Secretary Steve Barclay called unaffordable.
Instead, junior doctors have been offered a 5% rise this year, which was rejected, while there has been no offer so far for consultants.
Consultants are also calling for reforms to the doctors' pay review body to ensure the issue is "fixed for the future". Mr Barclay told Laura Kuenssberg he is "ready to have discussions" on other issues, such as how consultants' pay progresses over time.
"There's things we're open to discussing, but we need to get the balance right," he said.
The health service has been plagued by strike action throughout this year, with doctors, nurses, ambulance workers, porters and others walking out in disputes, mainly over pay.
A breakthrough came in May, when unions representing all NHS staff except doctors and dentists backed a deal to receive a 5% pay rise.
However, junior doctors and hospital consultants have still not reached an agreement with the government.
Health is a devolved issue, meaning this only relates to the NHS in England.
Ms Pritchard acknowledged that it would be several years before the situation in the health sector returned to anything like good enough, and stressed that the service was doing all it could to bring waiting lists down.
NHS England says more than 600,000 appointments have been cancelled in previous strikes. The ongoing failure of the government and some of the medical unions to find agreement is only going to crank the pressure up still further.
Ms Pritchard called for the industrial action to be brought to an end as soon as possible, saying it cannot become "business as usual in the NHS".
She also discussed NHS England's new 15-year workforce plan, which she introduced alongside Prime Minister Rishi Sunak earlier this week.
The NHS currently has one out of every 10 posts unfilled, creating major pressure on staff and leading to long waiting times for patients.
The new plan is focused on training and retaining more staff. Ms Pritchard said the plan is not an "overnight" fix , but that it is part of efforts to "treat people as quickly as possible, without delay".
Also on the show was former Conservative health minister Lord Bethell who described the current approach to treatment in the NHS as "rationing".
"If someone has a need for an operation and you simply don't have the resources to give them what they need then you are going beyond the important protocols of allocating scarce resources in the best way possible and you are being defined by the amount of resources that you have available," he said.
"I think that there is a difference between reasonable allocation of resources and making tough decision which is part of every day life, and having to cope with a system as overwhelmed with illness."
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2023-07-02 13:47:53Z
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