Confusion over pace of change. . .Nichol rules out havoc. . .Reform petition fears. . .Fundholder queue-jumping. . .'village idiot'gaffe

The NHS internal market is likely to produce few radical changes next year because managers are 'confused'about the government's message on the acceptable pace of change, according to an NHS Management Executive paper leaked to HSJ.It notes that health secretary William Waldegrave wants a 'significant shift'from historical referral patterns, but predicts a variable response.The Department of Health said patient benefits were expected next year, but any message took time to 'percolate'.

NHS chief executive Duncan Nichol said he was not prepared to 'risk havoc, particularly in central London', by changing the funding formula to weighted capitation too quickly.The Department of Health is examining a plan to shield London units from withdrawal of contracts by imposing a 'steady state' around the capital.London health authority chairs have appealed for it to await the 1991 census results before shifting more cash elsewhere.

A petition from more than 600 consultants calling for a halt to the reforms has raised concerns that doctors may be banned by their contracts from speaking out.A further 300 supported the petition but withheld their names for fear of persecution, says the NHS Support Federation.One who signed added: 'Here goes my merit award, perhaps my job.'

GP fundholders'patients should not 'jump the queue' but be placed on surgical waiting lists strictly according to clinical priority, says guidance from the Royal College of Surgeons.

Welsh health minister Nicholas Bennett is at the centre of a row with mental health campaigners after remarking:

'You used to have small villages with a village idiot, but there was a family structure looking after the village idiot.People do not feel it is their responsibility any more.'