Nearly half of family doctors say that community care for the old and mentally ill has led to a deterioration of existing services since its implementation in April 1993, according to a survey.
A quarter of GPs knew of disputes between health and local authorities over who should pay for services, while around four in 10 GPs reported that admissions to nursing homes and residential care have become more difficult in the past two years.
Almost two-thirds reported a decline in the provision of home help support services; about four in 10 GPs said meals on wheels and day care provision had worsened in some areas.
More than one fifth of GPs surveyed by the British Medical Association reported some improvement in services, with a split between rural practices and urban areas. Almost half of inner-city GPs said there had been a deterioration, compared with 22 per cent in rural areas.
The two Thames regions showed the greatest deterioration in services - 63 per cent in North Thames and 53 per cent in South Thames - while Northern Ireland had the largest number of GPs saying services have improved (37 per cent).
Dr Arnold Elliot, chairman of the BMA's Community Care Committee, said the regional breakdown was "disturbing" and revealed a "far from seamless service" between hospital and home as envisaged by the care in the community policy.
He highlighted the "very worrying" finding that only a quarter of the GPs had a named person in social services to contact about their patients or received a copy of the care plan for individual patients. These are requirements of the policy, designed to safeguard patients' health and well-being and identify any problems before they can develop.
Dr Elliot said that the findings suggested that resources for local authorities in some areas are "woefully inadequate".
Dr Judy Gilley, a member of the BMA committee, said carers - relatives or friends - were having to cope with a level of anxiety that would have been unheard of years ago.
The committee is calling on ministers to consider introducing national minimum standards for community care.
The BMA sent questionnaires to 1,500 GPs and received 493 replies, which were representative of the country, it said.Reuse content