NEWS: Waldegrave blames the bureaucrats. . . Internal market cost. . . Two-tier service. . . Budget deficits. . . Managers called to account

Defending GP fundholding, health secretary William Waldegrave said on television: 'If we give the doctors their own money, will it be better than giving it to all these bureaucrats in the districts and regions?

Yes, it has worked. The doctors know how to spend the money better. 'Institute of Health Services Management director Pamela Charlwood criticised Mr Waldegrave's 'inconsistency and illogic'.

Setting up the inte rnal market would cost£2bn and operating costs would be about£500m a year, Professor Donald Light of the New Jersey University of Medicine and Dentistry told the IHSM conference. He said the government had been 'misled' by US health economist Alain Enthoven, who had mentioned only the market's benefits and 'ignored 80 per cent of the reality'.

The Department of Health has issued guidance on whether provider units can treat GP fundholders' patients more quickly than others, after protests that the NHS reforms were creating a two-tier service. It allows fundholders'patients faster treatment only if others are not disadvantaged as a result.

Seventeen health authoritieswere unable to eradicate their deficits by 31 March, despite strong pressure from the Department of Health, an HSJ survey reveals. All but one have now agreed plans to shed a total of£16m from their recurrent expenditure before the next financial year. The average deficit is£1m and the largest just under£4m.

Disciplinary action should be taken against managers who commit serious mistakes in healthcare delivery, according to the Commons ombudsman's committee. Nurses and doctors often take the blame for complaints, but the fault sometimes lies with managers, the MPs say: 'Managerial staff responsible for serious mistakes move on rather than face the music'.