The proportion of patients able to get an appointment to see a GP within two days has fallen, the GP Patient Survey has revealed.
Exactly 80% of patients who sought a quick appointment got one last year, compared to 84% in the year before.
This highlights that one in five patients could not get to see a doctor within the 48-hour period and had to wait longer.
In comparison with the previous year, there were also falls in satisfaction with GP services.
However, the British Medical Association (BMA) said overall satisfaction levels remained high despite the extra pressure on doctors from the swine-flu pandemic.
The poll of more than two million patients in England found 71% who wanted to book ahead for an appointment could do so, down from 76% in the previous year.
Three-quarters (75%) of those wanting an appointment with a particular doctor could get one "all, or a lot of" the time, down from 77%.
Some 81% of patients were either very satisfied or fairly satisfied with the hours their GP surgery was open, down 1% on the previous year.
But more than half (56%) said they would like their surgery open at extra times.
Overall, 90% of patients in 2009/10 reported being either very satisfied or fairly satisfied with the overall care they received at their surgery, down 1%.
Dr Laurence Buckman, chairman of the BMA's GPs committee, said: "We believe there are better, more cost-effective ways to get genuine patient feedback, for example, through local patient surveys or through GP practice patient participation groups."
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"The third paragraph of your article is very misleading: it should have said 'that one in five patients SAID they could not ...' This is very different from reality. Perhaps they were saying 'they could not get an appointment with the doctor of their choice at the time of their choosing'" – Patrick Jordan, Manchester