Ambulance personnel attended nearly 285,000 incidents between April and June, a figure the Bureau of Health Information said was the highest since it began reporting the data in 2010.
Nearly 796,000 people presented to NSW's emergency departments between April and June, up three per cent from the same quarter a year earlier.
The figures cannot be put down to population growth, having outpaced that statistic since 2017/18.
Health Minister Ryan Park blamed the federal government, arguing it needed to "step up" and fund more GPs and other primary health services to stop people treating the emergency department as "quasi medical centres".
"We have a primary care system in freefall at the moment ... people are not able to access their GP in their community, so they're using the emergency department as an alternative," he said.
"Because they're not accessing GP regularly, they're turning up to our hospitals sicker."
Nearly 796,000 people presented to NSW's emergency departments between April and June. (Paul Braven/AAP PHOTOS)
NSW has done a lot of "heavy-lifting" on traditionally commonwealth measures such as urgent care services and GP bulk-billing initiatives, Mr Park said.
"To be blunt, they need to step up in this space … they need to be accountable for the part of healthcare they have to deliver, and that is GPs, that is primary health care," he said.
Federal Health Minister Mark Butler said a range of government programs were already operating, meaning extra funding wasn't the answer to the NSW crisis.
"We're reducing admissions through urgent care clinics, we're coming up with innovative ways to help older patients avoid going to hospital," he told ABC Radio.
The Australian Medical Association said NSW would have to bring more coin to the table.
"Our doctors, nurses and allied health staff continue to rise to the challenge, but how long can this continue before they break?" AMA NSW president Kathryn Austin said.
Only 64 per cent of emergency patients started treatment on time, down two per cent from a year earlier.
Australian Paramedics Association NSW secretary Brendan McIlveen said systemic changes were needed include triage reform, more specialist paramedics and regional health investment.
"We need a healthcare system that provides the right care for the right patient, at the right time, and we must review the system to include the voices of paramedics, dispatchers, and patients," he said.
Liberal MP Kellie Sloane said the influx of patients was "unacceptable" and would not be fixed if the state government simply blamed its counterparts in Canberra.
At the end of June, 1860 patients had been on the elective surgery waiting list for longer than clinically recommended, down from 9107 a year earlier.
