Governments in a number of Western countries are attempting to improve the efficiency, appropriateness and equity of their health systems. One of the main ways of doing this is to devolve purchasing responsibility from national and regional to more local agencies based in primary care. These primary care organisations are allocated budgets that span both primary and secondary services. This book draws on an extensive government-funded evaluation of the UK primary care led total purchasing experiment to shed light on important questions raised by these policies. In particular, it attempts to answer these questions: * Can general practitioner led primary care organisations successfully use an ability to purchase health services to achieve either more efficient or better health care for their patients? * What are the ingredients of more or less successful primary care purchasing organisations? * What lessons can be drawn from the experience of such a large and complex evaluation?