Thatcher warned of white paper stress... managers 'threatened with sack'... Clarke denies U-turn on GP contracts... grading jam...

Experts in tackling stress among NHS staff have warned prime minister Margaret Thatcher that her white paper will lead to more sickness, absenteeism, resignations and 'burn out'. A group including counsellors, psychologists, personnel officers and chaplains has urged a rethink of the proposals. It warned that 'overwhelming stress' will result from attempting to impose major change rapidly, without consultation.

General managers are being threatened with the sack unless they support bids for their hospitals to become trusts, consultants' leader Paddy Ross has claimed. He has accused some regional chairs of exerting pressure on managers to express interest in trust status by this week's deadline in order to bolster the figures, which total 129.

Agreement between health secretary Kenneth Clarke and doctors' leaders on the GPs' contract is being widely interpreted as a pointer to government compromise over the white paper. A deal was hammered out after 10 hours of talks. Mr Clarke denied it was a U-turn.

Health service unions are reporting a 'massive backlog' of regional nurse-grading appeals because of inadequate machinery to hear them. 'We predict they could be going on for years,' said COHSE.

HAs have been underfunded by more than£3bn over the past nine years, according to the National Association of Health Authorities. The shortfall was£490m in this year alone, it said.

Family practitioner committees are turning to income generation schemes to flesh out inadequate budgets and to cope with the white paper proposals. Projects include administering group contracts with Rentokil for disposal of clinical waste.