Methods: Needs for services for people with ischaemic heart disease were assessed for two defined county populations. Current clinical, epidemiological and health services research evidence were used to prepare technical descriptions of services. Data on needs and evidence of effective services were assembled into an interconnected matrix of information to advise the negotiations between the county authorities (the purchasers) and general practitioners, community services and hospitals (the providers).Results: Negotiations between purchasers and providers resulted in agreed specifications to commission services for people with ischaemic heart disease(IHD). Contracts for IHD services for 1996/7 will be based upon this method which applies to specific conditions instead of the previous historical cost and volume method. Use of the method has allowed target outcomes for services to be defined and agreed between the parties.Conclusion: Condition specific programmes of care appear to be feasible, relevant and potentially beneficial. It is possible to gain the co-operation of both managers and clinicians in defining service specifications, which are related to measured need and scientific evidence of effectiveness, for people with ischaemic heart disease. Initial failings of the market, in particular confrontation between purchasers and providers, can be reduced.J Epidemiol, 1996 ; 6 : S89-S92.