Total purchasing offers fundholding practices the opportunity to purchase all of the health care not included in fundholding for the patients on their lists. This report provides the first comprehensive picture of how the idea of total purchasing is being implemented in all 53 'first wave' national total purchasing pilot (TPP) projects in England and Scotland. The characteristics of the TPPs are discussed, as well as their organisation, management, financing, main objectives and purchasing intentions. The views of 'lead' GPs in the projects, representatives of providers and staff of local health authorities are reported.