Millions of people could miss out on health checks for potentially fatal conditions, an investigation has revealed.
Up to nine million patients may miss out on checks designed to spot potentially fatal conditions such as heart disease and diabetes, unless current provision and uptake improve, according to research for GP magazine.
One senior GP criticised the "ad hoc" programme, saying more central guidance is needed, while one health trust said carrying out the checks was not a priority due to "other pressures" and a charity leader warned of a "postcode lottery".
In April a mandatory target to check 20% of those aged 40-74 each year was introduced, having been an informal target since 2009.
The figures show that, in 2011-12, 1.7 million checks were offered to patients - 14% of all those eligible for the programme - and about 920,000 were actually carried out. This was an increase on 2010-11 when 1.1 million checks were offered and 645,000 carried out.
Around two-thirds (64%) of PCTs did not provide enough NHS health checks to meet the Government's 20% aspirational target in 2011-12, said GP magazine, which sent freedom of information requests to all 151 primary care trusts (PCTs) in England, of whom 118 responded.
One-fifth (21%) of PCTs admitted they will fail to meet the compulsory target in 2012-13, despite being given three years to prepare. Three PCTs did not provide a single check in 2011-12 and another provided just four checks.
Nationally, patient uptake is falling, with only 54% attending a check in 2011-12, down from 60% in 2010-11. Just 11% of patients in NHS Portsmouth turned up for their check. Despite government funding, six PCTs spent nothing on their programmes in 2011-12.
A Department of Health spokesman said: "The NHS health check is one of the best ways to identify those at risk of diabetes, strokes and heart and kidney disease. Preventing long-term illnesses saves lives and saves the NHS millions of pounds. The check is being rolled out nationwide and PCTs should offer them to qualifying patients. PCTs are monitored to ensure they deliver the programme."
Shadow health secretary Andy Burnham said: "Doctors gave explicit warnings to the Government that re-organising the NHS at a time of financial stress would damage patient care. Those warnings were ignored but it is exactly what is happening. Patients are paying the price for the Government's arrogance and inability to listen."