The King's Fund's report, ‘Patient choice: how patients choose and how providers respond', outlined that GPs have concerns about technical issues, the inability to refer to a named consultant and lack of directly bookable appointment slots.
It highlighted that despite technical improvements, GPs remain reluctant to use the system.
The report also looked at how patients who need a referral to a specialist are exercising their right to choose a provider.
It highlighted that patients living in non-urban areas were more likely to be offered a choice and more likely to choose to travel beyond their local provider than those in urban areas.
It also outlined that older patients, those from mixed or non-white backgrounds and those with no qualifications were more likely to think having a choice is important.
But it also said just 4% of patients consulted the NHS Choices website, with most preferring to rely on their own experience or the advice of their GP.
Anna Dixon, director of policy at The King's Fund and the report's lead author, said: ‘While it is still early days, we are some way from realising the vision of choice acting as a lever to improve quality, with informed patients choosing the highest performing providers in a competitive market.'