"When the February cap came in, again we held the line but then we discovered that other [hospitals] were not and not declaring it, or recruiting people under the cap with other benefits that were below the radar."

When pay rates were lowered again in April the hospital offered to pay more but had no applicants. "I think we didn't receive any CVs because we had become known as an organisation that held the line [on pay]. The issue is not the cap, it's about how it was applied. Trusts didn't act collectively," she said.

Dr Mann said: "I would be very surprised if Preston and Chorley were the only hospitals faced with this predicament at the moment. If you're already running a skeleton staff and then two more slots are gone the whole rota falls over. This surely shouldn't be the way we decide which hospitals are open 24/7."

Mark Pugh, medical director of the hospitals, said: "Changing the service provided at Chorley is a direct response to the immediate and significant staffing problem. We simply cannot staff the rotas, and it is an unacceptable risk to patient safety to attempt to provide an emergency department service with no doctors available to see people."