Unfit and overweight Britons will get doorstep visits from NHS staff to track those at risk of future illness, under radical plans for a new 'contract' between patients and doctors.

Doctors can now identify from postcodes where those most at risk of heart disease, diabetes or cancer are likely to live, Health Secretary Patricia Hewitt told The Observer.

Staff could then ask people in certain streets about their lifestyle - and invite those at risk for a health 'MoT' with their GP, after which they could sign agreements to lose weight or stop smoking if they were at risk of a serious disease.

'Instead of waiting for them to come to the doctor, the NHS has started going out to them,' said Hewitt. 'For most of us, our health doesn't just depend on the drugs, the doctor or the treatment the hospital gives us: it also depends on genetic inheritance and on the choices we make about our own lifestyle.'

Hewitt also admitted there was still 'a lot of frustration' among patients trying to book advance appointments with GPs and she called for the breaking of taboos over the way the NHS treats the dying, with greater efforts to ensure patients can end their lives at home. The government will pledge to double spending on palliative care in a white paper to be published at the end of this year.

Hewitt argues that there is strong public backing for an annual health screening such as that given to private patients, plus more intensive help from doctors for patients to ditch bad habits.

At least two primary care trusts were already getting staff to knock on doors in streets they had identified as high risk for disease, often in low-income areas, she said. The key was to use local people trained to recognise the symptoms and risk factors of looming illness.

GPs would then tackle those whose weight, high blood pressure or other habits gave cause for concern. 'We could offer them an annual check-up and then we might take that a step further and think about a contract between the individual and the NHS.'

The contract would agree goals such as losing weight or stopping smoking, but there would be no penalties for those who failed, she said.

The approach will be highly controversial, prompting charges of snooping on people's private lives and interfering in their freedom.

However, it forms part of plans to offer NHS care increasingly close to people's homes. Surveys show that, while almost two thirds of people say they would prefer to come home to die with their family around them, only 20 per cent do so - mirroring the problem that some women have in getting home births.

'Death is a taboo issue in our culture: it's about as far away from the Victorians as we can imagine, where death was publicly discussed and acknowledged, almost everybody died at home and you grew up familiar with the rituals of death,' she said.

'Some of the cancer charities estimate that, every day, 1,000 people die in the wrong place from their point of view, and this is dreadful. This is hidden and not spoken about.'

Hospitals had to become better at offering people the option - if it was clear they could no longer benefit from treatment - to go home and die with their loved ones, she said. The white paper will also examine what more support might be needed in the community to let that happen.