I was intrigued to learn that I am not the only person who has grappled with the meaning of 'health improvement' ('Health without a care', page 32, 2 November) and concur with the authors when they conclude that there is no single, consistent definition.

In terms of its impact on the work of primary care groups and trusts, for the first time primary care has an explicit public health remit which it can discharge effectively through its new, collective structure.

As an example, High Peak and Dales PCG has as its number one health improvement priority the provision of citizens advice bureaux in all its 17 main practices. Our pilot interventions have demonstrated the effectiveness of this approach in addressing the socio-economic needs of some of our most vulnerable patients, while having as valuable spinoffs significant income generation (from the increased uptake of welfare benefits) likely to contribute to local economic development and the saving of practice staff time. Recent research (Hobby and Abbott, 1999) also indicates that this intervention achieves measurable health gains.

Once PCGs/PCTs are more familiar with themselves as organisations, their public health role will blossom.

Julie Hirst Health promotion co-ordinator High Peak and Dales PCG