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From contracts to service agreements: what can be learned from total purchasing?

Total purchasing is an experimental extension of GP fundholding through which GP practices can purchase community, secondary and tertiary services not included in standard fundholding budgets, for their registered patient populations. The paper presents selected findings from a study of contracting by TPPs during the first year of purchasing, concentrating on the perceived relationship between aspects of the contracting process and the achievement of TPP's strategic objectives. These findings are of relevance to the development of commissioning by primary care groups in light of the Government's proposal that contracts be replaced by long-term service agreements as competition within the NHS internal market is replaced by more collaborative arrangements between commissioners and providers. The paper identifies features of the contracting process which have been instrumental to the achievement of TPPs' service development objectives and may need to be preserved to ensure effective commissioning within the context of the new service agreements.