The government's attempts to allow patients to select and book hospital appointments from GPs' surgeries by the end of the year is in serious risk of failure, a report from the National Audit Office has warned.

Ministers aim to ensure that by the end of this year all patients will be offered a choice of four or five hospitals for their operations.

There have been fears that grassroots GPs have been excluded from the development of the system, and will fail to engage with it once it is rolled out.

"Choice cannot be delivered without support from GPs; they will be responsible for ensuring that patients whom they refer for elective care are given the required choice of providers," said the report.

"The engagement of GPs is currently low, however, and is a key risk which the Department must address to deliver choice successfully."

Meanwhile the health secretary will today tell a local government conference that choice is empowering the working class.

"I think there is no contradiction between being a consumer and believing in publicly funded public services," John Reid will say. "It is the chattering classes that refuse to understand, or who claim that choice will benefit the middle classes."