Nursing unions have called for urgent action to stem the 'chaos' resulting from the collapse of contracts for the NHS 111 telephone service in England.
NHS Direct admitted that the 11 regional contracts it signed to deliver the service are 'financially unsustainable' and withdrew from all of them-threatening to leave over a third of the population without an NHS non-emergency telephone service.
Ambulance services in the North West and the West Midlands have pledged to provide call handling in the larger affected regions for the next year, until the new contracts are signed.
Dr Peter Carter, the RCN's general secretary, said: 'Despite the best efforts of their staff, some parts of the NHS 111 service are now in chaos, and urgent action is needed to prevent this from having tragic consequences for patients.'
NHS Direct chief executive Nick Chapman said: 'We will continue to provide a safe and reliable NHS 111 service to our patients until alternative arrangements can be made by commissioners.'
Last month NHS Direct warned that it was heading for a £26 million deficit this year if its volume of calls remained lower than expected. The price the operator was paid per call was cut from £20 to around £8 when the new service was introduced.
The health minister Lord Howe said: 'Their problem, I'm afraid, is that they got their sums wrong, which is very disappointing.'
But Unison's, deputy head of health, Sara Gorton, said the reduced price was resulting in a poorer service. She said: 'The new 111 service has far fewer nurses taking calls and the new service fails to clinically assess patients, leading to more patients being sent to A&E and to GP surgeries.
'The government rushed through the trials of 111 in its haste to increase private competition and it is patients who are now paying the price.'
Dr Carter also criticised the decision to split NHS 111 into 46 regional contracts. He said: 'This latest announcement raises concerns that a locally commissioned, fragmented system may simply not be able to provide the high standard of service and advice that patients need.'