German doctors are being flown in to the North East to provide emergency care for patients.
Local doctors in Sunderland do not provide out-of-hours cover
Under their contracts local GPs are now allowed to opt out of working weekends leaving Sunderland Teaching Primary Care Trust short of doctors.
To solve the crisis it is flying in foreign doctors to do weekend shifts.
But a spokesman for the trust stressed the expense of using them to plug the gap was not costing patients extra.
A Hertfordshire-based firm, Primecare, provides out-of-hours cover for Sunderland and tries where possible to use local doctors.
But this is not always possible and at weekends it regularly uses fully qualified agency doctors from abroad who are familiar with the area.
David Hall, assistant director of the primary care trust, said: "When the new contracts came in over a year ago, all GPs in our area opted not to provide out-of-hours cover, so the responsibility came back to us.
"With regard to the contract we have with Primecare, prices are already set at the outset so we do not pay for doctors on an individual basis.
"Therefore it doesn't matter to us cost-wise if they use a doctor from abroad or locally."
Maggie Ashbourne, of New Herrington, near Houghton Le Spring, relied on a German doctor to care for her husband, Joseph, when he got an infection after a knee replacement operation.
She said: "We needed a doctor urgently and a German doctor arrived who I have to say was absolutely wonderful. He stayed with my husband the whole time until the ambulance arrived and I was just very grateful."