Health recruitment agencies are sending unsolicited faxes to German doctors, begging them to cover for British GPs who have opted out of weekend work, the Guardian has learned.
The German Medical Association said that more than 2,600 Germans are flying regularly to the UK, usually commuting to Britain with budget carriers like Ryanair or easyJet.
Figures from the General Medical Council reveal that 771 German doctors registered for the first time to work in the UK last year when a new out-of-hours system came into being - double the previous year.
There are 3,764 German doctors registered to work in the UK, though not all are GPs. At times a third of the GPs doing out-of-hours work in one region alone, Northumberland and Tyneside, are from Germany. In parts of the country they can earn as much as £2,000 for a weekend's work.
Some British doctors are concerned that the unprecedented recruitment drive and influx of doctors from Germany and elsewhere on the continent is contributing to problems in the out-of-hours system.
Yesterday at a BMA conference in London family doctors warned that patients could die because of failings in the new system, including the reliance on foreign doctors.
Under new GP contracts introduced last year, family doctors can opt out of providing evening and weekend cover for patients with responsibility for the service being passed to primary care trusts (PCTs).
Unable to find enough local doctors to work evenings and weekends, the out-of-hours service providers are turning to Germany and other European countries.
Doctors from Germany relish the good working conditions, a more informal atmosphere than what they are used to and generous salaries, often more than £500 a shift, to be found in Britain. "It's very easy to earn £2,000 in a weekend," said Winfried Brenneis, a spokesman for Medical Transfer Services, one of more than 100 recruitment agencies that supply medical staff to PCTs.
He added: "Many German doctors fly on Thursday to Britain and stay until Monday. They often use the money earned there to pay off debts incurred in Germany when they buy their own practices."
But German doctors admitted there could also be problems. "I've told my German doctor friends not to go unless they think their English is good enough," said Sonja Michalke, who is commuting from Germany to Bury St Edmunds next week. "Sometimes it can be hard to understand a Norwich accent and German junior doctors get far less exposure to paediatric cases than their British counterparts. If you are the GP on a night shift you are responsible. If someone comes in with a child suffering from meningitis you have to get the diagnosis right."
British doctors are worried that their foreign counterparts do not understand the system and cannot always communicate effectively with patients.
At the BMA's conference of family doctors in central London, Andrew Green, a GP from Hull, said the new system had led to pressure to reduce costs and an increasing reliance on GPs from overseas. Dr Green said he knew of one doctor who arrived for an overnight shift in his area after a 12-hour journey from the continent.
GPs voted overwhelmingly in support of a motion demanding more money for the service.
Phil Dommett, from Cornwall and Isles of Scilly medical committee, feared that the complex needs of certain patients - in particular the elderly - were not being met. He said doctors needed to "fight" to preserve the out-of-hours service. "If you put the service under more pressure ... patients' health, and even their lives, will be put at risk," he said.
GPs at the BMA conference also voiced fears about the emergence of so-called "super surgeries". Many believe these larger practices, where many doctors and other health practitioners work from one building, will mean the demise of single-handed GP surgeries and the more personalised service they provide.
Dr John Dracass, a GP in West Hampshire, claimed there were proposals to "crush" single-handed and small practices in favour of giant surgeries of 10 or more doctors. He claimed the plans would mean that the current 10,000 British practices would "shrink to a miserable 1,800".
The Department of Health insisted that patients were getting a better service under the new system. A spokesman said: "The arrangement gives PCTs the opportunity to introduce an integrated out-of-hours service bringing together nurses, pharmacists, call handlers, paramedics, A&E and social care, as well as GPs."
The spokesman added that all out-of-hours services must now be delivered to national standards. Around £316m was provided last year and the same or more would be available this year. The Department of Health spokesman insisted there were no plans to scrap small family doctors.
