A survey of district general managers has found 78 per cent do not think the internal market reforms will tackle the NHS's funding problems,50 per cent say the reforms have diverted their energies from running the NHS and 25 per cent do not believe the changes will benefit patients.Philip Hunt, director of the National Association of Health Authorities and Trusts, which carried out the survey, said: 'Senior managers very much support the concept of the reforms. . . That is an important message for all parties with a general election coming up.'

Hopes of developing a national system of computerised patient medical cards have been deflated by the Department of Health. It says it has no plans for further tests following a pilot scheme in Devon which found 'evidence of potentially important benefits', according to an NHS Management Executive report, though it also found 'widespread criticism' because of technical problems.

Performance-related pay for community health council secretaries may compromise CHCs'independence, the Association of CHCs fears. Six of the 14 regional health authorities have now introduced PRP for CHC secretaries. ACHCEW director Toby Harris said: 'The RHA's view of what is the appropriate role of the CHC may be very different from that of the CHC.'

Health secretary William Waldegrave has ruled out significant revision of the GPs' contract imposed by his predecessor, Kenneth Clarke. But he is willing to talk to the British Medical Association's general medical services committee about 'where the contract is not working as expected'. GPs argue it has caused problems with paperwork, targets for screening, immunisation and deprivation payments, and health promotion clinics. GMSC chair Dr Ian Bogle is pressing for the Department of Health to examine immediately the contract's effects.