EVALUATION OF TOTAL PURCHASING PILOTS IN ENGLAND AND SCOTLAND AND IMPLICATIONS FOR PRIMARY-CARE GROUPS IN ENGLAND - PERSONAL INTERVIEWS ANDANALYSIS OF ROUTINE DATA

Objectives: To evaluate the reported achievements of the 52 first wave total purchasing pilot schemes in 1996-7 and the factors associated w ith these; and to 1996-7 and the factors associated with these; and to consider die implications of these findings for the development of th e proposed primary care groups. Design: Face to face interviews with l ead general practitioners, project managers, and health authority repr esentatives responsible for each pilot; and analysis of hospital episo de statistics. Setting: England and Scotland for evaluation of pilots; England only for consideration of implications for primary care group s. Main outcome measures: The ability of total purchasers to achieve t heir own objectives and their ability specifically to achieve objectiv es in the service areas beyond fundholding included in total purchasin g. Results: The level of achievement between pilots varied widely. Ach ievement was more likely to be reported in primary than in secondary c are. Reported achievements in reducing length of stay and emergency ad missions were corroborated by analysis of hospital episode statistics. Single practice and small multipractice pilots were more likely than large multipractice projects to report achieving their objectives. Ach ievements were also associated with higher direct management costs per head and the ability to undertake independent contracting. Large mult ipractice pilots required considerable organisational development befo re progress could be made. Conclusion: The ability to create effective commissioning organisations the size of the proposed primary care gro ups should not be underestimated. To he effective commissioners, these care groups will need to invest heavily in their organisational devel opment and in the short term are likely to need an additional developm ent budget rather than the reduction in spending on NHS management tha t is planned by the government.