An "expensive" Government health reform has so far failed to deliver real benefits for patients, experts have said.
Progress in implementing the policy has been "painfully slow" and, in some areas, has stalled completely, they said.
Practice-based commissioning, introduced in 2005, has also delivered little in terms of financial savings for the NHS, according to the new report from the King's Fund think tank.
The policy was introduced as a way of allowing GPs to run local budgets and "buy-in" services such as hospital and community care.
It was seen as a necessary step to providing more patient care in the community, thereby cutting costs and the number of referrals to hospitals.
The Government intended GPs to provide a range of services using practice-based commissioning, including diabetic care, diagnostic testing (such as X-rays) and dermatology.
But the report, which is the culmination of two years' work, found that very few GPs were using the scheme to commission new services.
This is despite the fact they have been paid almost £100 million in incentive payments, it said.
The report also said the Government had failed to learn lessons from the Conservative Party's similar experiments in the 1990s with GP fundholding.
And it called for a major shake-up of the reform, although it did not say it should be abandoned altogether.
