GPs in Oxfordshire are expected to be able to carry a pounds 3.1m surplus from last year into next - while Oxfordshire Health Authority predicts a pounds 3.1m defi- cit for the financial year.
The authority's problems have forced the John Radcliffe Hospital in Oxford to stop all non-urgent cardiac surgery this month except in cases where GP fundholders are guaranteeing payment. It has asked fundholders whether they will hand over some of their spare cash to help and a donation of pounds 200,000 has been agreed.
Dr Sian Griffiths, the authority's director of public health and health policy, and Nick Relph, the finance director, said the situation highlighted "nonsenses" in the fund- holding rules which unfairly favoured fundholders.
Unlike health authorities, fundholders are allowed to carry savings through to the next financial year. They also carry less financial risk as they are not responsible for emergency provision, which has seen a major increase in recent years, or services for patients, including mentally disordered offenders.
Dr Griffiths said: "It's not the fundholders' problem that the system is so different, but the pressures do not hit fundholders in the same way."
Nick Relph said the problem was potentially even greater next year as the authority, which holds the money for the fundholders, has already spent last year's pounds 3.1m GPs savings because it had a pounds 3m deficit last year too.
Mr Relph said: "Any health authority that has had significant savings by fundholders has done the same thing. It is certainly true of Berkshire and Buckinghamshire. We're all wondering how we will pay it back."
Dr Evan Harris, a doctor in Oxford and prospective Liberal Democrat party candidate, said: "This means that the service you get as a patient depends on the funding mechanism of your doctor. It's unfair and it runs contrary to clinical need."
And Chris Smith, Labour's health spokesman, said: "People are quite rightly angry that all over the country GP fundholders are making surpluses while health authorities and hospitals are going into the red. This is another reason why we are going to replace fundholding with a more equitable system of GP commissioning."
The cash crisis in Oxfordshire comes as evidence of the funding shortfall emerges across the country as predicted by doctors and health service managers last month.
Fazakerley Hospital in Liverpool has postponed all non-urgent operations after 14 patients had to spend the night in casualty because of a beds shortage last month.
The Queens Medical Centre in Nottingham has suspended routine operations for the whole of November and December - an estimated 350 operations. "They are not cancel- led completely, but if we carried on we would completely run out of money," a spokesman said.
The Royal Devon and Exeter National health Service Trust banned non- urgent elective surgery last August and will be performing no more until the start of the next financial year. A 10 per cent increase in emergencies would have meant an additional pounds 600,000 bill for the North and East Devon Health Authority, its major purchaser. "They did not have the money, so they requested we stopped all but emergency work," a spokeswoman said.
In the Southampton University Hospitals NHS Trust, some cardiac surgery has been put off because there was no money to pay for it. And the United Bristol Healthcare Trust has slowed down the rate of its routine surgery, extending waiting lists to a maximum 18 months, to help limit its projected pounds 500,000 deficit.