This chapter describes critical challenges and opportunities for contemporary primary care. It suggests how the creative approaches and solutions might become part of the mainstream, and thus contribute to making a real difference to the health of people living in urban disadvantaged communities. The chapter looks at the personal stories of staff in a community health project and in a general practice. Community Action on Health highlights a number of questions about the time and hard work required to engage with service users and the public. The challenge for public health is to resist being overwhelmed by the siren voices of the hard technical high ground of evidence, formal needs assessment and centrally set targets. The danger of a restrictive view of mainstreaming has been identified by a recent report called Inside Out: rethinking inclusive communities. The chapter also presents some closing thoughts on the key concepts discussed in the preceding chapters of this book.