The extraordinary potential of primary care to improve mental health.

We are currently experiencing many changes in primary care mental health services. Some would describe it as a revolution i , although the synonyms for this are not very appealing-mutiny, insurrection, riot, revolt. The RCGP is perhaps more creative describing 'a vision of primary care in the future.' ii Whichever words we use, The White Paper 'Equity and excellence: Liberating the NHS' iii introduced a raft of changes with the aim of 'putting patients first…trusting professionals [to] drive up standards and deliver better value for money and create a healthier nation.' Equity and excellence: Liberating the NHS' outlines the rationale for reform and the changes that will take place stating that " First, patients will be at the heart of everything we do. Second, there will be a relentless focus on clinical outcomes. Third, we will empower health professionals and through the development of clinical leadership, drive improved outcomes and efficiency and finally recognise the economic context and financial constraints. To achieve this, change is needed in many areas including commissioning, provider roles, public health, education and work force development, the collection and use of patient information, patient involvement and the role of local authorities. This is perhaps the best opportunity for years to tackle chronic under-investment, stigma and inequalities in mental health. Why is a renewal of primary mental health care needed now more than ever? Moving towards a vision of high quality, modern health for all requires that health systems respond to the challenges of a changing world and growing expectations for better performance. There are a number of issues that require substantial reorientation and reform of primary care.  There is an increase in the volume and complexity of health and social care needs more people live for longer with long-term and often multiple conditions.  There is a move to deliver more complex care in the community, as a means of both bringing care closer to patients and their families and reducing costs which requires ways of transforming services to reduce costs, whilst maintaining and increasing quality.  Recent fundamental changes to the structure of health and social care have the potential for greater service fragmentation as a result of the use of multiple competing providers and continuing barriers to better integration between health and social care. These long-term trends mean that expert generalist care is needed now more than ever. Only a healthcare professional with …