ABSTRACT
Total purchasing provides a model for locality purchasing and that over time there will be little difference between successful total purchasing and locality purchasing, regardless of whether its origins lie in fundholding or non-fundholding. Most total purchasing groups involve groups of general practitioners in different practices, who may have quite different ways of working and of using resources. The fact that emergency admissions continued to be purchased by health authorities while most outpatient care and elective surgery was purchased by fundholders led to fundholders not necessarily becoming involved in strategic purchasing. The health authority will need to set up monitoring systems to ensure that the total purchasing group is working to its budget and delivering agreed national and local targets. Trusts will need to make major adjustments for total purchasers. Many acute Trusts still have contracts that price emergencies on average specialty cost, which fundholders are unlikely to accept.
