Manchester City manager Pep Guardiola confirmed Kalvin Phillips is set to undergo shoulder surgery but remains hopeful the midfielder could return to action ahead of England's World Cup campaign.
Phillips, a key member of Gareth Southgate's side that reached the Euro 2020 final on home turf last year, made a £42million move to City from Leeds United during the close season.
Fitness issues have restricted the 26-year-old to only three cameos off the bench for the reigning Premier League champions, with Phillips entirely absent for Saturday's 3-0 win over Wolves.
Now the defensive midfielder, named by England for this month's final pre-World Cup games in the Nations League against Italy and Germany, looks likely to require an operation to deal with a persistent shoulder issue.
"It's a problem with his shoulder again," Guardiola said when asked about Phillips' absence for the Wolves match. "Maybe he will need surgery in the next days.
"It will be not long, but a little bit longer. The doctors say that when you are out three or four times with the shoulder, the only solution is to have surgery."
It marks a major blow for both Phillips and Southgate, with the former's chances of making the plane to Qatar now in the balance, and the manager left with a selection headache for his starting XI.
Despite limited minutes, Phillips would likely have resumed the double-pivot pairing with West Ham's Declan Rice in front of an England defensive line.
His potential absence could force Southgate into a change in formation, with Jude Bellingham and Jordan Henderson among the options pushing for a starting berth.
England kick off their World Cup campaign against Iran in a little over nine weeks' time, with the upcoming games against Italy and Germany providing Southgate with a final chance to see his side in action before the tournament begins.
Guardiola said there was "no way" Phillips could feature in either contest.
Asked if he could provide a timeline for the former Leeds player's return, Guardiola said: "I don't know, I am not a doctor.
"But in a good way he could arrive at the World Cup. I think so, but I am not a doctor. The doctor says the only solution right now is to do what we have to do."