Stuart Lancaster has been handed another injury headache after Tom Johnson became the latest player to be ruled out of England's autumn internationals.
The Exeter Chiefs flanker will undergo neck surgery next week.
He becomes the third player to be sidelined this week alone with Northampton Saints prop Alex Corbisiero and Leicester Tigers lock Geoff Parling also being ruled out with long term issues.
Lancaster will also be without Saracens prop Mako Vunipola, Dan Cole of Leicester and his Tigers teammate Tom Youngs for the forthcoming programme.
Johnson is expected to be ruled out for ten to 12 weeks, ending his chances of featuring in England's campaign which gets underway against New Zealand on 8 November.
"It's one of those awkward ones where there's a balance between waiting to see if rehab sorts it out or operate and try to get some immediate results," said Chiefs head coach Rob Baxter.
"Having spoken to the surgeon and then the surgeon having some debates with our medical staff, because it's a relatively straightforward one about trimming a bit of bone to free up a nerve, the consensus has been to get the operation done and give Tom the best chance to be good long-term, so we will do it now rather than wait and see."