Commissioners are failing to involve local voluntary organisations in decisions about services, a survey suggests.
Fewer than half of 200 groups from across England reported being involved in commissioning.
The work was carried out by voluntary sector umbrella organisation National Voices and the Royal College of Nursing.
Only 48 per cent of organisations said they had good experience of primary care trust commissioning, 35 per cent of practice based commissioning and 26 per cent of specialist commissioning by multiple primary care trusts or a strategic health authority.
Fifty-six per cent said they had good experience of local involvement networks - created last year - while 57 per cent said they had good experience of their predecessors, the patient and public involvement forums abolished in April.
National Voices chief executive David Pink said: "There is a whole lot of work left to do. Commissioners are meant to be getting to the so-called hard to reach groups, but they are not even reaching the listed organisations."