While this work is often described as a revision of the Piano Concerto, it is more correctly to be classed as an arrangement, the few genuine changes notwithstanding. The two-piano version came into being because the original was not particularly successful with either the public or critics. Conductor and friend of the composer, Adrian Boult, as well as other musicians, believed that the concerto's large orchestra and its often-dense scoring overwhelmed the soloist, and thus suggested that re-scoring the piece for two-pianos might offer more balanced sonorities.

Eventually Vaughan Williams came to accept their advice, though apparently not with great enthusiasm, since the work of arranging this score for two pianos was done by Joseph Cooper, under his direction. In the end, Cooper/Vaughan Williams left the first two movements largely as they were, though piano sonorities were fattened. Only in the finale were significant changes made, but not all were retained. The cadenza, for example, which occurs midway through the movement, contained a quotation from the epilogue of Bax's Symphony No. 3, which was discarded after the November 1946 London premiere. The most important changes occur near the end of the movement, when the piano soloists are given some new music to play, while some reprised material is eliminated. Also, the ending contains changes in its scoring, with subdued pizzicato strings playing the main theme, the work closing in the key of B rather than in G, as in the original.

There are three movements to the work, and the opening one, Toccata - Allegro moderato, is the shortest and most aggressive-sounding. In fact, it has largely been responsible for giving this concerto its unfair reputation of being grim and violent. The music here is driven, all right, and contains more than a few echoes of Bartók in its percussive keyboard writing. Yet, the main theme has a folkish quality and playfulness about it that help offset much of the driving momentum and steely glitter.

If the first movement vaguely suggests Bartók, the second (Romanza - Lento) more than remotely evokes Ravel, both in its main theme and in the bridging cadenza that connects it to the first movement. Vaughan Williams uses a lovely melody in the middle section that is a thinly-veiled variant on the aforementioned Bax theme. The outer sections of this movement divulge a somewhat bluesy character, not unlike that in the middle movement of the Ravel G major Concerto.

The finale is cast in two parts, as suggested by its marking: Fuga Chromatica, con finale alla tedesca. The first half presents its lively material in a fugal manner, while in the latter section Vaughan Williams treats it harmonically. A brilliant cadenza bridges the two sections and introduces a waltz, based on the fugal material. While this version of the concerto has its supporters, the original is generally the favored rendition.

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