Figures from the last round of SHA board papers show that primary care trusts are up to 50 per cent behind planned levels of the system in some parts of the country.
Even NHS North East, which had the highest choose and book take-up in the country, achieved less than 40 per cent of outpatient appointments through the system in November - nearly 40 per cent below its target for that month.
Despite being identified by several SHAs as one of six 'big tickets' to concentrate on, papers suggest a combination of IT problems, lack of engagement from GPs, and a failure by acute trusts to provide appointment slots through the system have left PCTs struggling.
In the worst-performing area, NHS East of England, just 20 per cent of appointments had been arranged through choose and book in November and the SHA reported that there had been a 'widening gap' between actual and planned performance. All PCTs in the SHA have now been instructed to produce 'recovery plans' in an attempt to hit March's target.
Other SHAs, including South Central, have also ordered PCTs to produce recovery plans, and some are monitoring booking statistics on a weekly basis to put pressure on PCTs and acute trusts.
NHS South East Coast achieved only 24 per cent of referrals in November, well under half of its target for that month of 59 per cent. The SHA acknowledged that the number of choose and book slots made available by acute trusts 'remains a concern', and trusts are being monitored to ensure they follow guidance on making appointment slots available.
North West SHA, which achieved 30 per cent of choose and book appointments in November, also accepts that March's target will almost certainly be missed.