Embattled urgent care telephone triage line NHS 111 has been dealt a further blow after NHS Direct confirmed it has pulled out of two contracts to provide the service, with the future of others in doubt.

NHS Direct, which previously ran the telephone line nationwide and won 11 out of 46 contracts in the switch to NHS 111, said it could not mobilise services in Cornwall and the Isles of Scilly or North Essex because the terms of the contracts are "financially unstable".

Nick Chapman, Chief Executive of NHS Direct, said following close discussions with local commissioners and NHS England, it concluded that it could not launch an NHS 111 service in these areas so must exit from the contracts. 

“We are very aware of the delays this has caused the new NHS 111 service in North Essex and Cornwall and the Isles of Scilly, and we have formally apologised to the commissioners for this," he noted.

However, judging by a recent NHS Direct board report, the contracts for services already up and running may also be heading for trouble. 

This is because call volumes are meandering at about 30%-40% of contracted levels, but as staffing levels are at or above those planned to handle the full 100%, NHS Direct said it expects to receive "substantially lower income than originally budgeted". 

'Financially unsustainable'

"The imbalance of costs and income on NHS Direct's 111 contracts means that each of the 111 contracts as they currently stand are financially unsustainable," according to the report.

Speaking on BBC Radio 4's Today Programme, Health Secretary Jeremy Hunt said: "it is really disappointing that in two parts of the country where [NHS 111] isn't up and running NHS Direct, who tendered for these contracts, who named their price, said what they needed to run it, are now saying that they got the numbers wrong".

NHS 111 has been beset with problems right from the start. Its nationwide rollout deadline was put back after the service was not ready in many parts of the country, and even those in operation were hit by claims of poor performance, clinical failings and inappropriate call handling.

Ministers have already launched an investigation into the service, following a stream of serious incidents including the deaths of three patients in which it may have played a role.