Plans by clinical commissioning groups to jointly procure NHS 111 and out of hours hotlines have sparked concerns that smaller providers could be squeezed out of the market.

These worries have been raised after a recent spate of joint procurement proposals, floated by CCGs in north west London, east London, Kent and Ipswich.

While experts welcome the more integrated approach that service merges might promote, they worry that procurement processes lack sufficient sophistication to allow smaller scale providers to win contracts.

Rick Stern, chief executive of the NHS Alliance, said joint procurement could leave smaller out of hours providers stranded.

“The difficulties are if this becomes another way of excluding smaller providers,” he added.

“If it means that commissioners are going to be supporting providers to work together under alliance or prime contacting arrangements with a bigger player that leads it, then that in itself would be a good thing, but frequently our tendering and procurements are not that sophisticated.”

John Horrocks, the chief executive of Urgent Health, which represents social enterprise out of hours providers, agreed closer working between 111 and out of hours made sense.

He was, however, worried that ambulance services, which currently run many 111 services, lack the expertise in primary care possessed by some social enterprises.

“Any solution needs to bring in the high performing social enterprise out of hours providers,” he added. “In the worst case you could see the existing very high quality social enterprise out of hours providers losing contracts and even more given to the ambulance services.”

Dr Mark Spencer, director of Fylde Coast Medical Services which runs a joint out of hours and 111 service, said the joint model had allowed it to draw up pre-prepared care plans for patients who regularly call. These can then be accessed by out of hours clinicians, ambulance staff, 111 call handlers and 999 staff.

“Integrating 111 with local urgent care provision is a very good idea,” he added. “It should be a fully integrated local service.”

Ian Greenwood, interim national programme director for NHS 111  said that the “resilience” and “ability” of providers should be decided locally.

“Commissioners have chosen different service models and they may choose to do this going forward – including integrating [out of hours] and NHS 111 services,” he added.

“NHS England is content with service models that meet local needs, but whichever service model is chosen there should be clear and agreed procedures that ensure the best patient experience across the urgent and emergency care system.”