The Public Accounts Committee report expresses serious concerns about the levels of savings fundholders are making and how well they are being spent. The cross-party committee says it is "disturbed by the [NHS] executive's apparent complacency" over the number of patients struck off.
"For some of the 78,000 patients concerned this must have been a very worrying experience," the committee says, noting that the executive knows neither whether the number has risen, nor what proportion were removed by fundholders and non-fundholders.
The executive must establish why the patients are being removed and by which type of GP, the MPs say, "to ensure that patients are not suffering discrimination on cost grounds".
The MPs are also worried that fundholders have accumulated pounds 100m in savings but they do not have to spend the cash for up to four years. The public spending watchdog says it is not convinced that the cash is well spent. The executive needs "to ensure unused NHS money is directed without undue delay to meet the needs of patients, including those elsewhere in the NHS".
The MPs are equally dubious about the management and start-up costs of fundholding, which in 1993/94 cost pounds 147m, including the purchase of computers. While the executive claims that patients have seen reduced waiting times and improved access as a result "it has not been able to quantify these benefits so far," the MPs say.
The committee says it is also concerned that the NHS cannot yet demonstrate that budgets are set fairly between fundholders and non-fundholders.
t General Practitioner Fundholding in England; Committee of Public Accounts, 27th report session 1994-95. HMSO; pounds 11.Reuse content