With her kidneys failing and doubled over in crippling pain, Lea Russ found herself alone on her rural property in north-east Victoria with no chance of help.

The nearest hospital to her home in Tallangatta was about 40 kilometres away, so she rang her regular GP at a medical centre in the next largest town.

When the receptionist answered, Ms Russ explained she was a kidney patient and had terrible pain.

The receptionist told her there were no appointments available for two weeks.

“The pain was unbelievable,” Ms Russ said.

“She said, ‘It’s not my problem. I’m just making appointments.'”

Ms Russ’s symptoms resembled constipation and she wasn’t sure whether it was severe enough to call an ambulance. Eventually, she realised she had no choice.

Once at hospital doctors quickly diagnosed peritonitis, a potentially life-threatening complication that can occur after a procedure called peritoneal dialysis.

“If I could have just talked to a doctor at the clinic they would have diagnosed it there and then,” she said.

Figures show a growing number of patients are facing this situation when they unexpectedly become unwell.

Between 2014 to 2022, the proportion of people who waited for 24 hours or more to see a GP for urgent medical care grew by 13.3 per cent.

Over the same period, the percentage of people who waited for less than four hours dropped by 14.5 per cent.

What Ms Russ didn’t realise was that medical centres are obliged to offer urgent appointments as part of being an accredited practice.

Medical receptionists should also be trained to identify urgent patients, so that they are prioritised for emergency appointments or urged to seek an ambulance.

“They don’t advertise urgent appointments,” Ms Russ said.

“I’ve rung in tears trying to get an appointment. [To me] they definitely aren’t trained.”

Chronic disease keeping GPs flat out

In its review of the GP workforce, published last year, the Australian Medical Association said getting a GP appointment has become more difficult as doctors deal with a rising burden of chronic disease and an ageing population.

Figures show GPs are working harder than ever, with an average GP billing 500 more Medicare services a year in 2022 compared to 2016.

Health Consumers NSW executive director Anthony Brown said its members frequently reported trouble getting appointments generally, and the situation was more difficult if they suddenly became unwell and needed an urgent appointment.

“Things are getting worse,” Dr Brown said.

“It’s not like a hospital where you have a triage system.”

GPs told the ABC that, in general, most physicians kept four to six appointments each day clear for urgent cases.

However, they often went to patients who phoned first thing in the morning to try and get same-day appointments, Melbourne GP Adam Wilson said.

Dr Wilson said it was usually left to the receptionist to determine who got the appointments because it would be expensive to employ a triage nurse.

Because of that, “urgent” appointments sometimes went to people who could probably wait, he added.

“If they’re a regular patient you will try to squeeze them in,” Dr Wilson said.

“They [receptionists] do get pressure put on them.”

Royal Australian College of General Practitioners president Nicole Higgins said it was a requirement for general practice accreditation to offer urgent appointments and train reception staff to triage appointments, but patients needed to flag they needed help.

“Sometimes we have mismatched expectations about what is urgent,” she said.

‘Not taking new patients’ policy leads to six-week wait

The difficulty getting a GP appointment is made even harder when clinics stop taking new patients.

This happened to South Australian woman Candice Pridham when she damaged her knee while walking her dog in 2022.

“There was no falling down. It just ripped,” she said.

Unable to walk without crutches, Ms Pridham called her regular GP and was told by the receptionist it was a six-week wait for an appointment.

When she explained she was in pain and asked to see another doctor at the clinic she was told those GPs “weren’t taking new patients”.

“It’s very concerning,” she said.

“I was quite aware that it was not an emergency but I did need to see the doctor.”

Six weeks later, and still on crutches, Ms Pridham saw her regular GP who diagnosed cartilage damage and she had surgery to repair the knee within a month.

She was very frustrated by the experience of trying to get an urgent appointment.

“You ring at 8am and the phone is engaged straight away,” she said.

“They never say, ‘Is this urgent?’. They need some sort of plan.”

The situation is expected to get worse with a deficit of more than 10,000 GPs nationally expected by 2032 as new doctors shun the specialty.

Should GPs be able to close their books? 

When GPs close their books to people living in the bush those patients are often left with a difficult choice: drive hundreds of kilometres to their nearest hospital or go without treatment.

The decision can also cause ethical problems, according to medical ethicist Wendy Rogers from Macquarie University.

Under the doctors’ Code of Conduct, GPs are obliged to treat patients in need and use their skills equitably, she said.

There was even a legal precedent that suggested GPs had a duty of care in emergencies.

“It’s problematic to say ‘you can’t have one of my emergency appointments’,” said Professor Rogers, herself an ex-GP.

But she said once a GP had a patient on their books, they had a specific obligation to that patient.

Taking on more patients could leave them overwhelmed or working unsafe hours, she said.

Dr Higgins acknowledged it was a challenge for people who did not have an existing GP.

“There’s short-term and also long-term reforms to support this,” she said.