ABSTRACT
Changes in policy and service provision have resulted in people receiving care from primary care, secondary care, social care, and voluntary and self-help organizations, and achieving lifetime patterns of care which differ considerably from those of the past. Attempts to improve the mental health skills and knowledge of general practitioners (GPs) are taking place but have a considerable way to go and 'top-down' initiatives are probably ineffective. Many people with apparently mild or moderately severe mental health problems may nevertheless require more specialized help at some point in their 'illness career'. The 'facilitator', who aims to identify and meet practitioners' training needs, appears a promising way to develop mental health skills within primary care. New initiatives in extending 'traditional' fundholding and developing total purchasing and local commissioning provide the biggest opportunity for changing the face of primary mental health care.
