But one senior GP warned the deadline was 'crazy' given that the pilot NHS 111 schemes across the UK were either incomplete, or yet even to begin.

Regions that fail to meet the deadline will automatically be signed up to a service that will be provided by NHS Direct, according to a letter from deputy NHS chief executive David Flory and DoH national director of efficiency and improvement for England Jim Easton.

Plans to roll-out NHS 111 services must be agreed and signed off by clinical commissioning groups (CCGs) and PCTs, and specify a ‘go-live’ or procurement date.

They must also make clear the geography covered by each service, and the operating model it will follow.

NHS 111 services are already live in four pilot areas – County Durham and Darlington, Nottingham City, Lincolnshire and Luton. Ten further pilot sites are to launch later this year to test further operational models, and a further five areas are due to launch 'full procurements this year' according to the DoH letter.

Derbyshire LMC secretary Dr John Grenville warned it was unwise to force NHS organisations to define NHS 111 plans now. 'It seems absolutely crazy. In Derbyshire a pilot is due to start in the next few weeks.

'How can we possibly know if we've chosen the right model until we know how the pilots have gone?'

Dr Grenville added that demanding key decisions over the summer was also a problem. 'The biggest risk is that strategic health authorities will not get this information by mid September – it’s the summer holidays. There aren’t enough people around.

'My feeling is that CCGs and PCTs are very busy with other things. And CCGs are getting to grips with what they might look like when the NHS reforms are complete, and getting people on their boards. They see their primary goal as commissioning of secondary care - not much thought has gone into plans for things like NHS 111 yet.'