Reforms not negotiable... Islington 'deplores' white paper... Vulnerable 'will lose out'... Boots' hospital invite... Ambulance tendering

NHS chief executive Duncan Nichol has told managers that the Working for Patients reforms are not for negotiation. They should be giving a clear direction to staff and creating a positive climate. But he added: 'This is not an exercise in prescription and detailed control.' Asked how managers should handle obstruction from health authority members who faced redundancy in 18 months' time, Mr Nichol said: 'I honestly don't believe it will be as bad as some people expect, but in some places it will be horrific'.

Islington HA has voted to 'deplore' key proposals in the white paper. Nine members supported a resolution describing the plans as 'expensive, ideologically motivated and destructive of the existing good service'. No one voted against, although HA chair Eric Moonman and four others abstained. General manager Cathy Hamlyn said the motion demonstrated the HA's 'commitment to the NHS'.

Vulnerable people will lose out to articulate middle-class patients under the reforms, the British Medical Association has warned. It criticised the government for 'ignoring the critical issue of underfunding', and it plans to launch a concerted protest campaign aimed at the public and MPs.

Pharmaceutical companies, including Boots, have been invited by two Scottish health boards to discuss the feasibility of tendering for hospital

pharmacy services. Grampian and Ayrshire & Arran boards have spent four months assessing whether specifications can be drawn up to put pharmacy services out to tender.

Plans to introduce competitive tendering for non-emergency ambulance services in Scotland are now underway in two health boards. Forth Valley and Lanarkshire have been chosen as pilot sites, and contracts for companies to provide transport to day centres and outpatient clinics should be running by October.