What were the achievements of Total Purchasing Pilots in their second year (1997/98) and how can they be explained?

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This working paper from the second year of TPPs makes the following key findings: larger TPPs are becoming high achievers; a group of TPPs (43 per cent) improved their performance over two years, about a quarter remained at the same level and about a third dropped out; a greater proportion of TPPs were concentrating on 'easier' areas; a smaller number of TPPs were tackling the more 'complex' areas; in most TPPS, the preferred mechanism for progress was through primary care development; and TPPs made less impact on services using commissioning mechanisms in the second year, although it was still seen as important. The evaluation of TPPs has three main implications for the government's proposed model of devolved purchasing; it will take considerable time for PCGs to construct robust organisations capable of bringing about important changes in local health services; effective GP-led purchasing organisations cannot be developed and maintained without substantial expenditure; and having a budget and developing independent contracts or service agreements is associated with more effective purchasing, at least in the short term.

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