The British National Health Service has been the focus of sustained political rhetoric in favour of greater public and patient involvement in decision making. The creation of Primary Care Groups—organizations based on local groups of general practitioners—has thus been accompanied by a requirement that they involve users and the public. This article reports on a study of Primary Care Groups (n = 167) to address two questions. First, how have the groups responded to this requirement? Second, can user and public involvement activities be related to broader changes with regard to the roles and expectations of citizens? The study indicated significant activity around public and patient involvement but also a tendency among informants to rationalize these activities in terms of a professional commitment to quality and responsiveness (rather than in relation to the expressed preferences of local citizens). In terms of the second question the results provide some, contestable, evidence of realignments in the values, priorities and assertiveness of individuals and communities of interest with regard to the state. The impact of such phenomena is, though, highly dependent upon how managers and clinicians in Primary Care Groups choose to prioritize the views of local service users and residents in relation to professional judgement, operational requisites, planning constraints and limited resources.