Total purchasing was introduced to the National Health Service in 1995 as a three-year pilot extension for volunteer fundholders of the controversial general practitioner (GP) fundholding scheme. Total purchasing pilots (TPPs) comprise one or a group of standard fundholding (SFH) general practices which receive a delegated budget from their local health authority to purchase (or commission) potentially all the hospital and community health services for their registered populations. In key respects, TPPs can be seen as forerunners of the primary care groups (PCGs) announced in the December 1997 English White Paper, The New NHS. This report draws together the interim findings from the first two years of a three year evaluation of all first and second wave TPPs in England and Scotland which began in October 1995.