By Marcus Wraight BBC Spotlight, health reporter

Trusts say improvements have already taken place

The Healthcare Commission examined how services were provided by area.

In the whole of the South West - from Cornwall to Wiltshire and Gloucestershire - four areas were deemed to be badly served.

Patients living in west and central Cornwall, Exeter in Devon, and Taunton in Somerset had "weak" services failing to meet minimum requirements.

Shortcomings could be in diagnosis, waiting lists, following guidelines or how different parts of the NHS work together.

We've come a very long way indeed since this review was undertaken Steve Moore, Cornwall and Isles of Scilly PCT

In Devon and Cornwall, the commission found that only in Torbay were patients getting "excellent" care that went "well beyond" what was required or expected.

A spokesman acknowledged that the report is based on figures that are 15 months old and the population areas are for primary care trusts that no longer exist.

Devon Primary Care Trust (PCT) says it has recruited extra nurses and reduced waiting times for some tests.

Jenny McNeill, assistant director of strategic commissioning, told BBC News: "We have taken significant action to improve the service in Exeter since it came to our attention.

"We would, of course, want to see the whole service reach an "excellent" rating in future."

Cornwall and Isles of Scilly Primary Care Trust and Royal Cornwall Hospitals Trust say they have worked together deliver "immediate improvements".

Steve Moore, the PCT's director of commissioning, said: "We've come a very long way indeed since this review was undertaken and we have developed an action plan, to ensure the service delivered locally is truly second to none."