Concerns have been raised that NHS patient care will deteriorate over the next few years.
A poll commissioned by the government before its listening exercise on the health reforms quizzed 5,000 NHS staff about their attitudes.
It found that almost half (49%) believe care will deteriorate, which is an increase on the 34% who expressed the same belief in the summer of 2009.
The survey found that GPs are the most likely to think patient care had worsened, although it found that "other staff views were catching up".
By comparison, just under a quarter (23%) thought local patient care had improved in the last year, which was 10% less than the number who thought the same in autumn 2008.
The poll also raised concerns about whether family doctors would have the capability to take on the commissioning roles planned for them under the NHS reforms, with 72% of GPs expressing the view that they did not have the capacity to take on the responsibility.