Media playback is unsupported on your device Media caption Howard Wensley: Using the 111 helpline was "like banging my head on a brick wall"

The NHS says it has experienced seven "potentially serious" incidents in the first few weeks of its 111 urgent care helpline in England.

One case involved a patient in the West Midlands who died unexpectedly and there have been reports of calls going unanswered and poor advice being given.

All the cases are being reviewed.

Other organisations are also running 111 lines for NHS England and have been warned they must deliver good care or face financial or contract penalties.

According to GPs' magazine Pulse, there have been 22 incidents classed as serious across all providers of 111 lines.

NHS Direct, which previously ran the phone line for people needing urgent treatment at evenings and weekends, has confirmed that seven potentially serious incidents on the 111 helpline it runs are being investigated.

The incidents occurred between 18 March and 11 April - which included the period when the service was being trialled, it said. During that time, it dealt with about 122,000 calls.

The organisation added it was "not unduly concerned" about the level of incidents.

A spokesperson said: "We take the responsibility for the safety and wellbeing of our patients extremely seriously.

"When a concern is raised we listen to the call and undertake an incident review involving experienced clinical staff. This allows us to identify clear actions so that lessons can be learnt and acted on quickly and thoroughly."

'Totally inadequate'

"It is extremely worrying that there is still so much uncertainty around the delivery and reliability of the advice provided by NHS 111 in some areas. Dr Clare Gerada, Royal College of GPs Q&A: NHS 111

NHS 111 is a free number for patients with urgent, but not life-threatening symptoms, including those who need fast medical help but who are not a 999 emergency.

It is designed to replace the NHS Direct advice line and out-of-hours GP call centres, with a more practical service.

Trained advisers who answer the phones offer basic health advice and direct the caller to the most appropriate area for their needs - A&E or GP out-of-hours services, for example.

But its launch has been plagued with difficulty, with some patients facing long delays before they had their calls answered and others abandoning calls altogether.

Seven of the 46 services across England are not yet in operation and a number of others have been suspended or are receiving help from other parts of the NHS.

One of the areas that has seen a 111 service start and then been abandoned is Greater Manchester.

A GP who was working when the system crashed said the service was "totally inadequate".

Dr Mary Gibbs told the BBC: "Patients' health was put at risk."

The British Medical Association has also repeatedly raised concerns about the 111 service being able to provide a safe and effective service.

'Losing confidence'

Where problems are identified with NHS 111, NHS Direct will continue to operate.

A contingency fund of £8.4m has reportedly been set aside to fund this until June.

NHS 111 The free one-stop number is for patients with urgent but not life-threatening symptoms

This includes people needing fast medical help but who are not a 999 emergency

Trained advisers who answer the phones offer basic health advice and direct the caller to the most appropriate service for their needs - A&E or GP out-of-hours services, for example

At the board meeting of NHS England on Friday, deputy chief executive Dame Barbara Hakin said the 111 service was operating well in the majority of the country, but there would be no further roll-out until NHS England was satisfied it could be delivered safely.

She said the service had improved from late March when the worst of the problems were encountered and plans were in place to cope with the extra demand expected over this bank holiday weekend.

A review into NHS 111 has already been announced.

An NHS England spokesman said: "The safety of patients must be our paramount concern and NHS England will keep a careful eye on the situation to ensure NHS 111 provides not only a good service for the public, but one which is also safe."

Dr Clare Gerada, chair of the Royal College of General Practitioners (RCGP), said: "The RCGP believes NHS 111 must be more effectively supported if it is going to properly direct patients to the most appropriate form of urgent NHS care.

"It is extremely worrying that there is still so much uncertainty around the delivery and reliability of the advice provided by NHS 111 in some areas.

"We are also concerned that patients are losing confidence in the new service before it is even fully up and running. We call on NHS England to provide more reassurance about its effectiveness and ability to deliver the necessary standards of care for all patients using the service, right across England."