Only 20 per cent of 52 PCTs that responded to a Picker Institute survey expected patient forums and community and voluntary groups to influence decision making.
This is despite the 2006 white paper Our Health, Our Care, Our Say warning PCTs that their annual performance rating will be affected by how well local people 'play a full part in the planning, design and delivery' of services.
In the last 12 months fewer than half the respondents (47 per cent) had engaged people in deciding priorities for commissioning, the survey found. This was a 'major gap between current practice and government expectations'.
Trusts were 'overwhelmingly' concerned with how services were designed instead of what services were needed by patients.
The survey also found that only a small minority of trusts are ready for key actions set out in the white paper.
Just six trusts had discussed how to manage patient-initiated petitions with their local overview and scrutiny committee and put petition-handling plans to its board.
Nine had developed plans on how their relationship with local involvement networks (LINks) would work when they replace patient and public involvement forums in April, and half had yet to commission a patient prospectus.
This was despite most PCTs stating they understood their responsibilities for the prospectus (98 per cent), petitions (77 per cent) and LINks (72 per cent).
The institute said PCTs should consider making its lead commissioner take on patient and public involvement - but there was a split between trusts on who should do the job.
About two-thirds of trusts, 69 per cent, said their public and patient involvement lead would take responsibility, while 31 per cent put forward a range of directors to head up the work.
The common reasons for failures to get the public involved in commissioning were difficulties reaching 'seldom heard' groups, a lack of public understanding of commissioning and a lack of reliable data of patients' experiences.
To make progress, most respondents (75 per cent) called for training, better data and opportunities to share best practice.
However, 73 per cent of trusts said they expected patients to be more involved in commissioning in the next 12 months and 48 per cent had designated part of the patient and public involvement budget.
Institute policy head Don Redding said: 'The results show the gap between what the government would like to expect and claim and what is actually happening.
'Part of the reason for this could be that the drivers are too weak and the incentives to do good patient and public involvement are not strong enough.
'Although there is some best practice, there is a big danger of some trusts just resting with existing procedures, finding innovation too difficult and that help is not at hand.'