- This report focuses on the 16 TPPs in England which pursued the objective of reducing acute hospital emergency admissions and/or length of stay to at least the end of the second 'live' year, March 1998. The analysis of hospital episode statistics was undertaken in order to establish whether the action taken by these TPPS to change emergency hospital activity had any impact. By the overall measure of impact used in the study, 69 per cent of the pilots were successful. The report distinguishes between multi-practice and single-practice TPPs, because the multi-practice pilots offer greater insight into the issues faced by primary care groups (PCGs). The commissioning of emergency hospital services was the pilots' raison d'etre. The finding that only a minority of the pilots pursued objectives of reducing acute hospital emergency activity, indicates that the challenges to be overcome are considerable. The total purchasing experience has implications for PCGs and primary care trusts attempting to manage their use of, and expenditure on, acute hospital emergency services. Although they were volunteers and comprised fewer practices than PCGs, these pilots demonstrate that general practice can influence the use of emergency hospital services. However, primary care organisations will require a high level of co-operation from acute hospitals and health authorities in order to secure appropriate funding for alternative service provision.