- This report summarises the hospital activity analysis for two types of first-wave total purchasing pilots (TPPs), 'commissioner' TPPs and 'co-purchaser' TPPs. The main objective of the analysis was to compare changes in hospital activity, in the areas for which TPPs had objectives, with those of comparators. The authors conclude that: TPP 'commissioning' can be an effective method to bring about change in the use of secondary care services where TPPs choose to make it a priority; most 'commissioner' sites were not able to negotiate length of stay-sensitive pricing; and the conclusions that can be drawn about the co-purchasing model are limited. Primary Care Groups (PCGs) at Level II will be similar to 'commissioner' TPPs with regard to their budgetary responsibility for the purchase/commissioning of health care. Hence, there is considerable potential for Level II PCGs to manage demand for unplanned secondary services at least as well, if not better, than the health authorities have done to date. Whether this leads to efficiency gains depends on managing total demand and releasing resources fom acute hospital contracts.