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Taywood and Amec's exit followed close behind that of Wates and Carillion, who announced their decision to quit at the end of last week. Medicinq has suspended its participation while it reviews its position.

Amec's decision to leave means that Costain is the sole surviving member of the AMC consortium that it formed with Mowlem and Carillion in 2003.

Costain this week said it would remain on the framework despite the latest developments. A spokesperson for the company said: "We are fully committed to Procure 21 and fully intend to stay in health, which is one of our key sectors."

The departures follow a lengthy period of deepening frustration among many Procure 21 participants, each of which had to pay an annual fee of £500,000 to be a framework partner. Most members of the framework were angry with the uneven distribution of contracts: since the initiative was launched the lion's share of the work has gone to two contractors - Laing O'Rourke and Kier.

Those remaining on Procure 21 are Balfour Beatty, Costain, HBG, Integrates Health Projects, Interserve, Kier Health and Laing O'Rourke.

Little of the workload that the industry envisaged has come through

Taywood spokesperson

Paul Drecshler, chief executive of Wates, never made it a secret that he was sceptical about Procure 21 after he joined the contractor at the end of 2004. This week he said: "This wasn't sudden for us. If you pay an annual fee, you expect to get a benefit. Frameworks and partnering are the right way to go but Procure 21 was a very unique and ineffective procurement route."

Rob Smith, the DoH's director of estates, said he regretted the change but added that he remained "confident that the remaining partners will be able to handle the expected increase in Procure 21 work and that trusts are still offered sufficient competitive choice".

A spokesperson for Taywood said the company had written to Rob Smith this week "regrettably to say that we are withdrawing from the framework. We feel it is no longer in our best commercial interest. Little of the workload that the industry envisaged has come through".

An Amec spokesperson said that the company was "in the throes" of quitting the programme as a tier-one provider but emphasised that it would continue to carry out services on behalf of Interserve.