Attempts to “stitch together” different models of provision for the new NHS 111 non-emergency phone number could lead to a fragmented service that will struggle to cope with peaks in demand, the Ambulance Service Network has warned.

Information collected by HSJ reveals that although primary care trusts in the North East, the South West, Yorkshire and the Humber, West Midlands and the South East Coast have banded together to procure the service but it has not been decided whether it could be provided at PCT, cluster, or regional level.

New pilots are due to go live this month in Derbyshire, Lancashire and Cumbria, London and the Isle of Wight. These are in addition to the existing four pilots in County Durham and Darlington, Nottingham City, Luton and Lincolnshire. 

All SHAs were required to provide the DH with go live or procurement dates for their PCTs by 23 September or be opted into a service overseen by the DH and provided by NHS Direct, the local ambulance trust and out of hours services. HSJ understands few areas are considering this option at this stage.

Providers of NHS 111 must keep an up to date directory of local services to which callers can be referred and be able to dispatch an ambulance directly.

Ambulance Service Network director Jo Webber told HSJ it was too soon to begin procurements when the evaluation of pilots was incomplete.

“The level at which this is commissioned is really important; if we commission too many the problem is about resilience and how you cope with great surges in demand. It feels fragmented and we need to be clear what the GPs want from this,” she said.

“The public will expect this to work without hitch and able to deal with any peak in activity. Trying different models out is brilliant but trying to stitch them together [into a nationally consistent service] could be difficult.”

Andrew Gardner, chief executive of out-of-hours provider Harmoni, which is leading the delivery of the pilot in Hillingdon, London and due to go live this month, told HSJ he had been surprised how quickly the procurement process was moving.

He said the company’s modelling suggested an NHS 111 service would need to serve a population of six million to be viable in terms of the call centres needed to cope with peaks and troughs in demand and the “sophisticated” telephony and IT systems needed.

In London four pilots have been approved, meaning 37 per cent of the population will be covered by next spring, while pilots will be introduced across the capital in time for the April 2013 deadline. A spokeswoman for NHS London said the learning from the pilots would be used to inform a pan London procurement exercise during 2013-14.

Three of the four pilots will be delivered by out of hours providers.