The successful implementation of the NHS reforms hinges on the development of district health authorities as effective purchasers of health care for their residents. The NHS has always been provider driven and if services are to be delivered more efficiently and responsively then it is essential that health authorities are established as agencies which can challenge providers and hold them accountable for their performance. This report describes some of the joint purchasing arrangements which have been undertaken so far. The experience summarised here draws mainly on initiatives pursued in six areas: Chester/Wirral; Buckinghamshire; East Sussex; North Yorkshire; Manchester; and Ealing.