Primary care organisation and management. Evidence from a total purchasing pilot

This paper reports the experience of a single pilot in total primary care purchasing (TPP) between 1995 and 1997. The article's structure is based on a framework created from the seven original objectives of the pilot and 12 themes emerging from qualitative data analysis. Data are mainly drawn from interviews with participants. Interesting and useful findings emerge. For example, the TPP was able to build positive relationships with other local actors and amongst its GPs, though these did not necessarily lead to agreement or compliance. The TPP undertook conventional health needs assessment, but experienced difficulty reviewing referral practice and controlling the volume of secondary care services, contributing to problems of financial control. Though TPP has been abolished, the findings have implications for successors.