Total purchasing pilot scheme

52 pilots

In 1994, the government invited local areas to bid to become total purchasing pilots (TPP). The 52 pilots ran until 1998.

TPP allowed general practitioners (GPs) in a locality to purchase all hospital and community health services for their patients. TPP allowed general practices – either individually or in groups – to hold budgets delegated from health authorities. They could use these to commission all services for their patients, though most were highly selective in what they chose to purchase.

The pilots had the power to purchase:

  • maternity services
  • services for seriously mentally ill patients
  • community care for frail elderly patients
  • emergency medical inpatient services
  • accident and emergency services
  • emergency medical inpatient services.

Some practices that wished to influence purchasing with colleagues in other practices were allowed to experiment with different models of purchasing.


An evaluation of the TPPs was published in 1998. The evaluators found that distinct types of pilot evolved.

Most of the pilots were 'commissioners' who held a delegated budget and directly purchased care. Others sought to influence commissioning decisions, by working closely with the health authority, rather than directly holding a budget.

The evaluation found that the level of achievement between pilots varied widely. Although fundholders were free to purchase all hospital and community care services, GPs restricted themselves, so they rarely commissioned the full range of services.


Goodwin G, Mays N, McLeod H, Malbon G, Raftery J.
Evaluation of total purchasing pilots in England and Scotland and implications for primary care groups in England: personal interviews and analysis of routine data.
1998; 317(7153): 256.