By Nick Triggle
Health reporter, BBC News
GPs are meant to guarantee patients appointments within two days
A review is under way after a report by an NHS watchdog suggested many GPs were missing their waiting time target.
Doctors should be able to guarantee patients an appointment within 48 hours under the terms of a new contract.
But the Healthcare Commission's annual report for England showed GPs in less than a third of trusts were hitting the target, down from 80% the year before.
The data is based for the first time on the views of patients - but doctors and the government said it was misleading.
The 48-hour target was written into the 2004 contract, which has seen GP pay rocket to over £100,000 a year on average, after complaints patients were having to waits days and days for an appointment.
Local health bosses working for primary care trusts (PCTs) have been charged with finding out whether the target is being met.
They have previously done this by ringing GPs anonymously - although critics say doctors often know when officials are doing the ring-rounds.
But in 2007-8 patient surveys were also taken into account for the first time and the combined results showed that just 31% of PCTs could guarantee most of their local patients could be seen in the two-day timeframe.
NHS RATINGS 2008
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Gary Needle, of the Healthcare Commission, said he could not rule out that GPs had been misleading about their performance and it was now up to PCTs to find out what has been happening.
"We don't know what accounts for the disparity - that's the next step.
"But there's clearly something happening here.
"If it was only a 10% difference then you might say patients were not understanding the exact question put to them, but you can't explain away this scale of difference in that way.
"Patients are not getting sufficient access."
But Dr Hamish Meldrum, chairman of the British Medical Association, the trade union for doctors, said the figures were "misleading" and GPs were working hard to offer speedy access.
"There has been such significant change in the way the research has been compiled compared to last year that it is impossible to compare the data for the two years in question."
He said other research had shown that patients were happy with access.
The Department of Health agreed other feedback from patients had shown patients were satisfied.
But a spokesman added: "Anyone who thinks their GP is not providing this service should take the matter up with their local PCT."
The Healthcare Commission report has also raised questions about the government's success in tackling MRSA infections.
The report acknowledged rates were falling, but that not all trusts were making enough progress.
However, overall NHS performance has improved after three years of the watchdog's so-called health check.
THE SIX DOUBLE-WEAK TRUSTS
Royal National Orthopaedic Hospital
Scarborough and North East Yorkshire NHS Trust
East of England Ambulance Service
Great Yarmouth and Waverley PCT
North Yorkshire and York PCT
The system relies on a series of reviews, patients surveys and self assessments to judge the 391 NHS trusts on their quality of services and use of resources.
It showed that for quality of services, 26% were excellent, 36% good, 34% fair and 5% weak. Two years ago, only 41% were excellent or good, while 59% were weak.
For use of resources, 24% were excellent, 37% good, 34% fair and 5% week. Two years ago, just 16% were excellent or good, while 84% were fair or weak.
In total, over a third of trusts improved their ratings.
The performance has prompted Healthcare Commission chairman Professor Sir Ian Kennedy and Health Secretary Alan Johnson to write to 57 of the best performing trusts to congratulate them on their achievements.
Sir Ian said: "Patients and the public should celebrate these results as they show a real shift in performance."
However, the watchdog warned the weak trusts - six of which were judged weak on both measures - that they would face intensive monitoring over the coming months.