The board of the NHS England has warned organisations running the new NHS 111 urgent care helpline they must deliver good care - or face penalties.
Just days after it was revealed the service is seen as "fragile", the NHS board said poor performers could face financial penalties or even have contracts withdrawn.
There have been reports of calls going unanswered and poor advice being given.
However the board did say the service was working well in 90% of England.
NHS 111 is a free one-stop number for patients with urgent, but not life-threatening symptoms, including those who need 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
It is designed to replace the NHS Direct advice line, as well as out-of-hours GP call centres, with a more practical service for those needing urgent but not emergency care.
End Quote Dr Clare Gerada Royal College of GPs"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. "
But its launch has been plagued with difficulty, with some patients facing long delays before they had their calls answered and other 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 be abandoned is Greater Manchester.
Doctor's concernsA 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.
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.
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.
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."
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