PATIENTS across the Hunter are waiting as long as six weeks for an appointment and being hit with bills of up to $70 because of a critical and continuing lack of general practitioners in the region.
More than 50 Hunter practices are recruiting for doctors, with 32 in rural areas and 19 in the urban division area.
Unrestricted bulk-billing has all but disappeared, with many doctors claiming they have no choice but to charge upfront fees to avoid going out of business or being overrun by patients.
Only a third of the region's urban practices have their books open to new patients without any restrictions, a phenomenon increasingly common in Maitland and west Lake Macquarie.
A surgery at Cessnock reported having its books closed for seven years and another at Pacific Palms has been trying to recruit a doctor for more than four years.
In the Upper Hunter patients are travelling more than 40 kilometres to see a GP with one-doctor towns being left stranded as ageing doctors fall ill, slow down or retire.
More than half the Hunter's urban GP workforce is aged over 50, and 21 per cent are aged over 60.
The number of full-time equivalent GPs servicing the urban area dropped from 296 in 2001 to 290 this year and over the same time the population increased by about 60,000.
The Australian Medical Association has warned that the Hunter's primary health-care crisis is deepening and not expected to improve unless the Government radically changes the way it delivers services.
The view is echoed by both bodies governing GPs in the Hunter, GP Access, formerly the Hunter Urban Division of General Practice, and the Hunter Rural Division of General Practice.
GP Access chief executive officer Mark Foster warned that if market forces were applied in the region, some Hunter GPs would be justified in charging more than $100 for a consultation.
Dr Foster said surgery waiting times stretching into weeks was a "direct signal" there was a real shortage of GPs and "we have a problem".
"The reality is GPs have been trying very, very hard to ensure that market forces don't apply," he said.
"A perfectly reasonable response to the situation we face would be to charge more, see the patients willing to pay and not worry about anything else. But GPs are concerned about their patients' care and are worried about what is happening."
Hunter Rural Division of General Practice chief executive officer Alison Crocker said GPs played an integral role in rural communities, often delivering babies and performing surgeries.
Dr Crocker said many GPs were on call 24 hours a day and if they got sick there was no one to take their place.
"The impact on patients is huge throughout the community and the more rural the area, the bigger the impact," she said.
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