purchaser. The purchaser in the NHS is increasingly going to demand evidence of the outcomes ofmedical care in contracts, and not just details of the process. This book is a collection of essays arising from a conference on this issue. As with any such book, it has its high spots and its depths. An introduction by the chief medical officer was interesting, but contains a statement that there is wide variation in mortality in young male diabetics in England above a table which clearly shows the opposite. Parts on orthopaedic outcomes left me cold, but a section on death rates as a comparator of performance were very interesting, as were chapters on cost effectiveness, and the development and implementation of clinical guidelines. While outcomes in a well-defined area such as total hip surgery should be relatively easily measured, I was left wondering how to monitor outcomes in my own general medical practice, with its broad case mix. This book does not provide the answer, but may stimulate some thought.
Postgraduate Medical Journal