Only four in 10 GPs have signed up to a government scheme seen as essential in developing more community NHS services.
GPs have been able to take charge of local budgets since last year
Practice-based commissioning was set up last year to allow GPs to run local budgets and buy in services - such as hospital, physio and community care.
GPs can keep most of the savings they make to reinvest in specialist local services, like diabetes clinics.
Some 3,454 of the 8,500 practices in England have signed up, but the number actually commissioning is much lower.
Family doctors have been able to assume control of budgets from primary care trusts since April 2005
GPs are said to be more responsive to need as they act as gatekeepers to the NHS and will commission more innovative services in community settings
To give them an incentive to avoid hospital care, GPs are able to keep most of the savings they make to reinvest in local services
In places where it has been adopted, doctors have used the money to develop specialist services, such as diabetes clinics
It is estimated that a little over a quarter are running their own budgets, although 3,454 have been given the incentive payments to prepare for the responsibility.
The payments only commit doctors to drawing up a plan to start commissioning, not to actually doing it.
The government wants to see all GPs adopt practice-based commissioning by 2008, but will miss the target if the current take-up rate continues.
Ministers believe the new system will lead to a reduction in unnecessary hospital admissions as GPs look to utilise community services which cost less money.
The government has made moving care out of hospitals and into the community one of their key NHS priorities following a white paper earlier this year.
Local health bodies - primary care trusts - currently commission services in most areas, but GPs are considered more responsive to local need.
A report by the NHS Alliance, which represents primary care professionals, said in areas where the scheme has been taken up savings of more than £1m have been made.
But Dr Hamish Meldrum, chairman of the British Medical Association's GPs committee, said doctors were being put off by the deficits many NHS trusts were struggling with, believing they would then be passed on to them.
"Implementation of PBC is very patch at the moment. While we support it in principle, we hear of far too many barriers being put in the way of GPs taking on a commissioning role."
But Health Minister Lord Warner said he was "pleased" with the numbers coming on board.
"Practice-based commissioning gives frontline staff a greater say in how health budgets are spent for their patients.
"It's all part of our aim to give patients much more access to convenient treatments, which are often closer to home."