A £2m contract with management consultants to prepare West Midlands regional supplies organisation for the internal market has come under fire from the district general managers of financially pressed health authorities. They have voiced concern at the money paid to United Research while hospitals are closing beds to make ends meet. South Warwickshire DGM Duncan Allison said: 'I see it as a public scandal: £2m is an horrendous sum for one small supplies organisation to spend trying to find out how to do its job.'

GP fundholders will have the right to demand that consultants see their patients. In a pilot project at Airedale General Hospital, fundholders' patients will take a note to outpatients indicating whether they need to see a consultant or not. Other GPs' patients will not have the same right. North Yorkshire local medical committee secretary Dr John Givans said: 'There will be a lot of anger around if the benefits for fundholders last too long without being shared by the rest'.

A vigorous debate is understood to have taken place in the NHS Management Executive over how many firstwave trust applications should be recommended for approval. Finance director Sheila Masters argued no risks should be taken with those which faced an uncertain financial future. But trust unit head Peter Griffiths disagreed. He advocated keeping faith in trust managers to see the projects through.

Patients at Bournemouth's Royal Victoria Hospital will be offered lobster and salmon with hollandaise sauce if they pay a£5 top-up fee for an a la cartemenu. But the community health council condemned the scheme as two-tier catering. The Department of Health launched guidance in September on selling extra services to patients.