Performance reviews. . .Inner city immunisation. . .Health authority mergers. . .Doubts over 'centre of excellence' Trade union NALGO is calling for changes to individual performance reviews and performancerelated pay, which it claims have fallen into 'disrepute'. In its submission for a 12.5 per cent pay rise for up to 4,000 senior NHS managers, the union says that IPR's 'proper application is not universal.This would be disturbing even if it were not related to performance pay, but since it is, the trust of our members in its outcomes is shaken'.

The 'success story'of almost 90 per cent of GPs hitting their immunisation and cytology targets, announced by the Department of Health, masks serious problems in inner cities where some GPs may have stopped doing this work.Family health services authority managers had warned that the new GP contract introduced in April would lead to inner city practices feeling they had no hope of reaching the targets and triggering payments.

More health authorities are planning mergers as managers conclude that the current size of purchasers is rendering them ineffective.Three HAs in south London may form a single agency, while three in Buckinghamshire may amalgamate to cover the whole county.Purchasers feel they need to employ health economists, medical geographers, sociologists and statisticians, but most do not have the money.

The Independent Healthcare Association has voiced doubts about US company Health Care International's plan to build a£180m 'centre of excellence' in Clydebank, the majority of whose patients would come from abroad.The IHA is sceptical that HCI could attract sufficient such patients since they are declining in number as governments improve native healthcare systems.HCI says it will also take Scottish NHS patients if asked to do so by health boards.