The Department of Health has issued 'contradictory' regulations on the role of community health councils, CHCs claim. Though they now have the right to represent patients when family health services authorities hear complaints against GPs, rules issued last week say CHCs have 'no role in the relationship between a GP and their individual patient'. The DoH said CHCs would clearly have a major role in representing the consumer's voice in the reformed NHS.

Several district general managers resigned last week either to take up posts as unit general managers heading bids to become trusts or to leave the service altogether. East Surrey DGM David Leggett said: 'Many DGMs see self-governing trusts as a high-risk venture, and many of them, with the money offered, would see it as demotion. Meanwhile there is a real possibility that the role of the chief executive of a new health authority could be quite boring and narrow. '

The NHS Management Executive must strengthen its authority over HAs or it will be held to account by Parliament, said Commons public accounts committee chair Robert Sheldon. The committee has condemned the Executive for being too slow to investigate variations in perinatal mortality. Mr Sheldon said it should instruct regions and districts to improve mortality rates.

HAs face a 'bleak' future in nurse recruitment unless they offer flexible terms, the King's Fund Institute has warned.

Severe shortages already apparent could get worse unless managers make nursing more attractive in terms of pay and conditions, it says.

Health secretary Kenneth Clarke has rejected proposals for a private insurance healthcare system from the Conservative No Turning Back group. 'My main objection to it is that it does not work, 'he said.