And companies who have won a place on the Procure 21+ framework are wondering exactly how much work will be procured through the system in the light of planned Government spending cuts.

Laing O’Rourke, BAM and the Medicinq consortium containing Midas, Osborne and Simons were dropped from the framework by health chiefs.

The decision is a bitter blow to the firms who were part of the original eight-strong Procure 21 framework which has delivered projects worth nearly £2bn since its inception in 2002.

Costain was one of the original Procure 21 contractors but decided not to tender for the new Procure 21+ framework.

One contractor close to the negotiations told the Enquirer: “There are some big names who have lost out but the biggest surprise is Laing O’Rourke who have won a lot of work through this and been involved in the delivery  of so many successful projects.

“These firms have built-up large departments to oversee this work and also have long supply chains so the fallout could be huge.”

But yesterday’s announcement was better news for Willmott Dixon who are one of two new faces on the framework alongside the Healthcare Partnership Solutions consortium containing Miller Construction.

The source said: “Of course getting on the framework is a major boost for anyone but the simple fact now is that no-one knows how much work will be coming through Procure 21+.

“We will have a clearer picture come the comprehensive spending review later this year and our hope is that health spending will be protected and the government will see capital spending as an investment.”

The new framework will streamline and simplify the process for NHS Trusts when procuring a construction company to carry out hospital refurbishments or new builds.

NHS Trusts can now choose from:

• Balfour Beatty

• Healthcare Partnership Solutions

• Integrated Health Projects

• Interserve Project Services

• Kier Regional

• Willmott Dixon Holdings

Under the new framework, work can start on projects within six weeks, saving the NHS at least six months in the pre-construction period.

The appointments will take effect when the new framework commences on 1 October 2010 and will run for a six-year period.