A leaked email has revealed that only two doctors were covering a population of over 1.4 million overnight prompting one manager to deem an out-of-hours provider "unsafe".

In a message to senior managers about social enterprise IC24 - which runs out-of-hours care in Kent, Sussex, Norfolk, Suffolk, Essex and Northamptonshire - service delivery manager Lesley Williams wrote about the unacceptable situation faced by the county on a September night, blaming it on a lack of staff.

"Having seen the screen myself this morning I need to let you know that the service is currently unsafe and has been overnight," she said, according to a report in healthcare journal HSJ.

"We had two GPs and one [advanced nurse practitioner] in East Kent and two ANPs in West Kent overnight.”

According to HSJ, at the time of Ms Williams' email - 8am - the service across all of Kent, except Swale and Medway, had 130 people waiting for advice, 67 waiting to be seen at bases, and nine visits to make.

Included in this were two West Kent patients in palliative care, one of whom was "actively dying", and doctors in East Kent had to prioritise.

One non-life threatening call out took place at 1pm on September 8 with a doctor attending to the patient at 6.15am the next day, partly due to a clerical error.

The email, given to HSJ, continued to doubt whether there would be any clinicians working in Maidstone that morning, anticipated that there would be no Canterbury cover in the afternoon and no doctor based at Dover or Margate that evening.

IC24 told HSJ that mobile clinicians and other bases covered these gaps.

In a statement given to HSI, IC24 said it was currently exceeding its obligations on staffing levels, and has contingency plans when staffing was “lower than desired”.

"These include moving staff according to demand, and staffing fluctuation," it said.

"On a weekly basis we assess issues such as the longest waits patients experienced, assess the potential impact on those patients, and report back to our clinical commissioning groups, with whom we have close working relationships to ensure quality of service."

The service had planned to have a GP in West Kent overnight but this shift had not been filled.

"The delays experienced by two palliative care patients in North and West Kent during the weekend of September 8 to 9 have been reviewed to ensure that no harm was caused to the patients as a result,” the statement to HSI added.

Staff were encouraged to report incidents they considered unsafe and these are investigated by a senior clinician, it said.

A spokesman for West Kent CCG and the four east Kent CCGs told HSI: “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.”