More than a third of doctors in England feel the Government's tiering system will have no impact on efforts to contain the spread of Covid-19.

That is according to a wide-ranging survey from the British Medical Association (BMA), which also raises concerns about the confidence of healthcare staff for the autumn/winter period.

More than half of healthcare staff say they are "quite anxious" about the coming months.

Almost two thirds (65%) said staffing shortages are a concern in the months ahead, while 60% said they are concerned about their personal health and wellbeing.

When it comes to dealing with patients 58% said they are concerned about the ability to cope with demand from non-Covid patients, and 44% said they were worried about the ability to cope with demand from patients with Covid symptoms.

Asked to what extent they believed the current rules for tiering in their area will be effective in containing the spread of the virus, more than a third (37%) said they felt they would have no impact or be ineffective, less than half (46%) said they thought they would work to a slight extent and just 5.95% said a significant extent.

More than 6,000 medics were questioned as part of the survey and the findings show the "enormous scale of the challenges" facing the NHS into winter, the BMA chairman said.

Dr Chaand Nagpaul said: "Doctors know that this winter is likely be one of the most difficult times of their careers.

"They are extremely worried about the ability for the NHS to cope and their ability to care for the needs of their patients."

The BMA said it is calling for the Government to be "both honest and realistic with the public about whether the NHS can cope with routine care and Covid care this winter".

What happens if your area is in Tier 3?

Around 2.8 million people in Greater Manchester joined some 3.1 million in Lancashire and the Liverpool City Region already under the most severe restrictions in the early hours of Saturday.

In these areas, social mixing is banned both indoors and in private gardens, while pubs and bars must close unless they can operate as a restaurant.

The rule of six applies in some outdoor settings such as parks, public gardens and sports courts.

Local leaders help the Government to determine whether other venues should be closed, such as gyms or casinos.

In Greater Manchester, the new measures could lead to the closure of more than 1,800 pubs and 140 wine bars, as well as 277 betting shops and 12 casinos, according to the real estate adviser Altus Group.

In the Liverpool City Region, indoor gyms and fitness studios were forced to shut, alongside sports facilities, leisure centres, betting shops, adult gaming centres and casinos.

Gyms in Merseyside are now allowed to reopen in line with other areas under the toughest local lockdown restrictions.

Gyms remain open in Lancashire but the adult gaming industry, casinos, bingo halls, bookmakers and betting shops, and soft play areas were made to shut.

Shops and places of worship can remain open, as can schools and colleges, while universities must reflect wider restrictions with the option to move to greater online provision.

Up to 15 guests are allowed at weddings and 30 people can attend funerals, with 15 allowed at wakes, but wedding receptions are not permitted.

People living in Tier 3 areas are advised against overnight stays in other parts of the UK and should avoid travel where possible in and out of the area, unless it is for work, education or caring responsibilities.

Number 10 confirmed that, under Tier 2 and 3 rules on household mixing, people can still meet up for work meetings indoors under certain circumstances.

What happens in Tier 2 and where is affected?

Areas categorised as high risk have restrictions on household mixing indoors while the rule of six continues to apply outdoors.

People must not meet socially with friends and family indoors in any setting unless they live with them or have formed a support bubble with them.

Up to 15 guests are allowed at weddings and up to 30 people allowed at funerals, with 15 allowed at receptions and wakes.

Shops, gyms, all education settings, and places of worship can remain open, with overnight stays permitted.

Travel advice for those living in Tier 2 areas is to reduce the number of journeys they take where possible and avoid travel into very high Tier 3 areas.

Areas in Tier 2 include Cheshire, Derbyshire, West Yorkshire, Durham, Northumberland, Tyne and Wear, Tees Valley, West Midlands, and Leicestershire.

London, Essex, Elmbridge, Barrow-in-Furness, York, North East Derbyshire, Chesterfield and Erewash moved to Tier 2 last Saturday.

First Minister of Wales Mark Drakeford confirmed a two-week “firebreak” lockdown in the country from Friday until November 9, and those living under Tiers 2 and 3 in England were already banned from travelling across the Welsh border from Friday last week.

What restrictions are placed on areas in Tier 1?

Areas classed as medium risk, those in Tier 1, are subject to the same national measures which were commonplace across England earlier this year.

These include the 10pm curfew for pubs and restaurants and a ban on most gatherings of more than six people.

Up to 15 guests will be allowed at weddings and up to 30 people allowed at funerals, with 15 allowed at receptions and wakes.

Shops, gyms, all education settings, and places of worship will remain open, with overnight stays permitted and no travel restrictions within the area, although people are advised to avoid travel into Tier 3 areas where possible.

Almost a fifth (19%) of those questioned said in the two weeks leading up to the mid-October survey they had seen a significant increase in the number of Covid cases and it was higher than the same point in the first wave.

Some 11% said while their local health system has plans in place to be able to address the backlog of patients whose care was cancelled, delayed or otherwise disrupted amid the pandemic, they had not yet made any progress, while just over a quarter (27%) said they had made some.

Only around a third said they have premises that are currently suitable to adequately separate Covid and non-Covid patients - a statistic the BMA said highlights how difficult it will be to meet an expectation of resuming normal NHS services.

Dr Nagpaul said: "Large numbers of doctors across England have little faith that the Government's current 'tiered' based lock-downs will have any significant impact on controlling the virus.

"Instead of a few short weeks of suppression, bringing economic and emotional misery for those in the areas affected, we need a national prevention strategy that has a lasting impact and gets growing infection rates under control across England."

The BMA said 6,610 doctors in England took part in the survey during the week of October 19.

A majority (70%) said they had not contracted coronavirus.