Joint purchasing pilots. . . new staff grades plan. . . health unions closer to merger. . .hospitals face autumn rein-in. . . £16m services to contract out

Two pilot projects to promote joint purchasing of primary and community health services could signal the first steps towards creating a unified primary healthcare commissioning authority.

Cambridgeshire family health services authority general manager Geoff Meads said: 'Our strategic direction is towards becoming a primary care authority supporting the integrated provision of services'.

NHS personnel directors have been urged to create new staff grades in order to 'blow apart the system' of national pay talks.The call was made by NHS personnel director Eric Caines, who used a DoH circular on healthcare assistants - which he called a 'blockbuster'- to create new groups of staff 'from top to bottom'.He added that personnel directors could have 'all the freedom you like'.

Unions NUPE, COHSE and NALGO have taken a step nearer to merger with a joint report outlining moves towards a single union representing 1.5 million public sector workers within two years.They are bidding to become the single union for NHS staff and the natural choice for negotiation with trust chief executives.

Health authorities wanting to change traditional patient flows in year two of the internal market reforms will be expected to warn affected hospitals by the autumn.It is clear that regional health authorities will attempt to maintain strict control over the market next year in a bid to avoid unexpected closures.

HA support services worth£16m a year are being lined up for contracting out in the biggest deal of its kind in the NHS.P&O and Pall Mall, a subsidiary of Godfrey Davis, have been shortlisted for the contract with West Berkshire HA, which includes all the HA's administrative and clerical work.