However, GP fund-holding has produced some benefits, notably in making hospitals more responsive to family doctors' views. The evaluation also finds that NHS Trusts do have the potential for greater efficiency and some of the worst fears about what the changes would do to equality of access to treatment have yet to materialise.
But the studies, funded by the King's Fund, the independent health think-tank, suggest Department of Health claims that NHS Trusts have performed better than other hospitals is probably due to them being compared to other units before the reforms.
While there was a sharp rise in the numbers of patients treated, it would have been 'astonishing' had there not been, given the large extra sums pumped into the NHS ahead of the last election. 'On their own, such indicators can tell us nothing about the progress of the reforms,' Julian Le Grand, one of the co-ordinators of the studies, said yesterday.
GP fund-holding is one of the success stories of the reforms, the study says, and the problems it has created over two-tier treatment could be solved by extending the scheme to all GPs - an option ministers are known to be examining.
But fund-holding has few friends as it challenges the established power of hospital consultants, health authorities and the NHS management executive. The studies say that as fund-holders take more of the budget, the role of districts becomes questionable.
The studies argue that with the reforms only a year or two old, 'there is only limited evidence' that they have improved NHS performance and evaluating the changes has been made difficult by parallel but separate reforms - the new GPs' contract, the Patients' Charter and the new-style community care.
But Sir Duncan Nichol, the NHS chief executive, insisted that: 'The reality for patients is that the NHS has reduced waiting times; it has increased the level of treatments; and it has achieved significant improvements in the quality of care provided.'Reuse content