This report aims to describe the experience and adequacy of budgetary and risk management arrangements of all first wave Total Purchasing Pilots (TPPs) in 1996/97. The results of a postal questionnaire sent to every TPP manager were analysed. The authors conclude that TPPs have taken seriously the management of expenditure in activity-based contracts and have kept this expenditure within budget. Multi-practice TPPs have found it more difficult to keep expenditure within budget than have single practice TPPs, and are more likely to be changing their budgetary management systems for 1997/98. Most TPPs were worried about the financial risks caused by rare costly referrals. Most had made arrangements to manage these risks. More than one in ten reported problems due to overspending that were caused by inadequate financial provision. Large TPPs were no better at managing these risks than small TPPs. More rigorous risk assessment and risk management strategies are needed and these require access to data on activity rates and prices.