Total purchasing was the first major 'internal market' policy initiative to be extensively evaluated by the Department of Health and Scottish Office. This report draws together the main evidence from the evaluation in order to inform the development of the new primary care organisations in the NHS, which came into being in April 1999. It looks at three aspects of the operation of total purchasing pilots (TPPs): effective organisations, service change and how it was achieved, and the importance of national and local support, and makes suggestons about the future development of the new primary care organisations based on the evaluation of TPPs.