HSJ 28February 1991 - NHS Executive shake-up. . . Caines gets Guy's key job. . . Fundholding rethink. . . Cash curb on GPs in hospitals. . . Emergencies clampdown

A radical shake-up of the NHS Management Executive has been given the go-ahead after the blunt admission that it was 'not geared to managing the NHS'. IT and procurement may be hived off to agencies, while the trusts unit will be disbanded. The recommendations in the review, carried out by operations and planning director Mike Malone-Lee, are expected to be implemented within two years, coinciding with the Executive's move to Leeds.

Karen Caines, head of the Department of Health's trusts unit, has been appointed unit general manager of Guy's Hospital in south London, less than two months after NHS deputy chief executive Peter Griffiths was made chief executive of Guy's and Lewisham Hospitals trust.

The future of GP fundholding may be re-examined after the next general election. A DoH source suggested that there is concern that fundholders may disrupt the managed market in healthcare now favoured by Whitehall. 'GP fundholding jeopardises the idea of maintaining a steady state in the internal market, and that is being acknowledged now, 'the source said.

Financial restrictions are standing in the way of a proposal to reduce junior doctors'hours by increasing the number of GPs working in hospitals. The British Medical Association said that health authorities were cutting back on employing GPs as they were more expensive than house officers.

London acute hospitals are routinely refusing to accept emergency referrals until forced to do so, according to the Emergency Bed Service. In January,46 per cent of admissions arranged through the EBS were imposed in this way, compared with 29 per cent the year before. In the first week of February the proportion reached a record 53 per cent.