South Worcestershire Primary Care Trust - which will next week debate the future of Evesham Community Hospital - has lost one performance star in the latest annual ratings announced by the Department of Health this week.
And chairman David Barlow admitted that there were a number of key targets where further improvement was required.
"It is always disappointing to lose a performance "star" after a year of exceptional hard work and commitment from all our staff and I would like to place on record my thanks for all their efforts," he said.
"The Primary Care Trust continues to operate rigorous financial control but I am confident the PCT is making a real difference in the challenge to improve health in South Worcestershire."
There was better news, though, for the Worcestershire Mental Health Partnership which went from no stars to the top-rated three stars over the past year.
Chairman John Calvert said: "To Ros Keeton, our chief executive in her first year in the job, to our consultant and senior management team and to every single member of staff I want to say on behalf of the Board a big thank you and well done - you can't do better than the best."
Hereford and Worcester Ambulance Service, a three-star service last year, also lost a star in the latest rankings from the Healthcare Commission.
Chief executive Russell B Hamilton said: "I must recognise the hard work and dedication of every member of staff and volunteer.
"I am very pleased that we hit all of our key targets despite the challenge of a major increase in calls.
"I am also pleased that our achievements in risk management and our continuing work in safeguarding children have been recognised. I am disappointed that given all of our hard work over the last twelve months that we were unable to retain our three-star rating."
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