Only two doctors were left to cover out-of-hours GP services in an area with a population of more than 1.4 million, it has been reported. GPs’ leaders condemned the situation as “completely unacceptable” after a manager had called the staffing level in Kent unsafe in an email to bosses.

The Health Service Journal (HSJ) cited a leaked email that said the two GPs in question were forced to decide who had priority for visits, including some patients in palliative care, besides their own duties during an overnight shift on a weekend in early September.

It said the email was sent at 8am, when the service across most of Kent had 130 people waiting for advice, 67 waiting to be seen at bases and nine visits scheduled. This included at least two palliative care patients in west Kent, one of whom was described as “actively dying” but waited six and a half hours for a visit.

“Patients can’t determine when they will fall ill and they should be able to access high quality GP care when they need to, either through our routine service or GP out of hours services,” said Prof Helen Stokes-Lampard, the chair of the Royal College of GPs.

“It is essential that any out-of-hours care services are staffed appropriately … If patients are unable to access GP care out of hours due to staffing shortages, and GPs working out of hours are being put in a position where they are having to make decisions about which seriously ill patient needs their help most, it is completely unacceptable.” She called for more investment in out of hours services.

According to the HSJ, the email to senior managers read: “I need to let you know that the service is currently unsafe and has been overnight. We had two GPs and one [advanced nurse practitioner] in East Kent and two ANPs in west Kent overnight.”

Out-of-hours cover is provided by the social enterprise IC24. Dr Andrew Catto, its deputy chief executive, said: “In common with many public services, staffing levels in out of hours primary care vary throughout the time our service operates, as certain times are busier than others – especially the weekends, when in-hours primary care is less available.

“It is well known that there is a shortage of GPs. This impacts on many GP surgeries and out-of-hours services. IC24 values the contribution of our GPs. But, in common with other out of hours providers, we benefit from having access to a team of healthcare professionals including nurses, urgent care practitioners and paramedics.

“These highly skilled healthcare professionals meet the clinical needs of our patients using out of hours care. The role of the GP is also changing; rather than needing large numbers of GPs to deliver hands-on care, GPs play an essential role in also providing high-quality expert advice to nurses and paramedics.”

A spokesman for NHS West Kent Clinical Commissioning Group (CCG) and four of the five east Kent CCGs said: “The CCGs monitor the performance of the out-of-hours provider daily, along with weekly reports. There have been no serious incidents reported. Where a gap in workforce is identified, for instance through sickness, the provider puts contingency plans into place. This means that patients will continue to have access to health professionals when they need it.”

• This article was amended on 26 November 2018. A previous headline referred to the doctors covering an area with 1.4 million patients.