A practical guide to primary care groups and trusts Edited by Michael Dixon and Kieran Sweeney Radcliffe Medical Press 280 pages £22.50

This book is both fascinating and important, not only for what it says, but also for what it doesn't say. The editors, Michael Dixon and Kieran Sweeney, are to be congratulated on persuading more than 30 contributors to take time away from their workplaces, and the major changes they are implementing, to write about their experiences.

As they point out in their preface, 'the success of the primary care system will depend on the motivation and ability of 'the few', the relatively small number of movers and shakers. . . the unsung heroes. . .'.

The five sections of the book are theory, functions, people, getting it right, and the future. The eight chapters on people, all averaging six pages, are personal reflections on individual roles in the emergent primary care system and the more substantial academic pieces on 'the theory' and the 'functions' provide a useful framework towards the practical insights in 'getting it right'.

If you really want to understand the issues about involving patients in management of the NHS there can be no better introduction than the three chapters on theory by Donna Covey, the experiences of the lay member by Roy Latham and practical approaches by Debbie Freak and Ruth Chambers.

Between them, they provide some extraordinary and helpful insights into this highly complex and difficult area.

Plunging into this book gives one a sense of the excitement and challenge that engage our leading primary care specialists. But this book has a more frightening message for us all, and that message is linked to its omissions.

The index is robust and well constructed, but I thumbed through in vain for references to NHS Direct, emergency admissions, waiting lists, walk-in surgeries or accident and emergency attendances.

I could also find no indexed references to mental health at all.Working through the book I found a fleeting aside: 'ways of accessing and delivering information will include. . . helplines (including NHS Direct)'.

I am left concerned about what could only be described as a form of myopia among some of the most energetic and thrusting of those involved in primary care. It seems to be a very real possibility that the enormous agenda of creating primary care groups and trusts means that, to some extent at least, they have taken their eye off the ball.

Is it the uncertain nature and status of mental health trusts which has prevented primary care organisations engaging with them over the last year? And why are PCOs not in close dialogue with NHS Direct and A&E departments over the continuing rise in emergency admissions which puts such huge pressure on hospitals?

In summary, I think this is an excellent and valuable book and would urge anyone who wants to understand what's going on in primary care to read it - but it might leave the reader with some worries about the change agenda and its impact on broader healthcare.