“Our fear is that patients, who can often be extremely worried or distressed, will receive a stripped-back service from NHS 111, with more being advised to dial 999 or got to A&E, which is far more costly.

“At a time when the NHS as a whole is under pressure to make savings, it seems nonsensical that one part of the health service is in effect picking up the tab for another.

“If these workers lose their jobs they may struggle to find future employment within a healthcare setting and as a result the NHS will lose their expert skills.”

NHS Direct is not the only organisation tendering to deliver NHS 111 services. The new system will allow private and GP out-of-hours providers and the ambulance service, among others, to deliver this service.

County Durham and Darlington was one of only four areas across the country to pilot the NHS 111 service and to date it has answered more than 200,000 calls.

Since then there has been a 14% reduction in the number of calls received by 999, a 3% reduction in the number of 999 incidents and a 9% reduction in accident and emergency attendances compared to other areas with a similar demographic in the North East.

Simon Featherstone, chief executive of North East Ambulance Service NHS Foundation Trust, said: “We are extremely pleased to have been awarded this contract.

“It’s a significant milestone in fulfilling our mission to ensure that patients in the North East receive the right care in the right place at the right time.

“This is a testament to the durability and resolve of a dedicated team to bring this to fruition in a way which has widespread clinical acceptance in the North East.

“As the first region in the country to implement NHS 111, we hope that our experiences, with enlightened partners at Connecting for Health, NHS County Durham and Darlington and Northern Doctors Urgent Care, will help benefit others as they seek to roll the service out across the UK.”