Mental health is a core issue in primary care and primary care is now becoming a key collaborator in developing and delivering quality mental health care with ongoing, underpinning support from a raft of government policy directives. These include the introduction of new roles into primary care such as Graduate Primary Care Mental Health Workers and the introduction of a number of new quality outcome indicators to the new GP contract and the opportunity for GPs to undertake commissioning of mental health services.

Recently changes to the new GP contract have increased the focus on reliable diagnosis, monitoring and management of chronic mental health problems in primary care. In addition, the new roles, designed to help in the support and management of individuals with mental health problems offer an alternative to traditional ways of managing mental health problems in primary care. These innovative changes have impacted on traditional ways of working and helped promote a more collaborative integrated approach to care of patients with SEMI.

Despite this emphasis on improving organisational relationships and partnership working through the introduction of these new policy initiatives, evidence suggests that the implementation of policy and development of mental health services, has to date been varied. The experience of those working within, and delivering mental health services suggests a rhetoric reality gap between policy formulation, implementation and service organisation and delivery. This has particular implications for people with mental health problems, many of whom have little choice or voice within society and need integrated services.