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A large proportion of general practitioner appointments are taken up by those with mental health problems and the overwhelming majority of these patients are handled exclusively in primary care. In the face of challenges both national and local, we give an account of our experience of primary care mental health service redesign in Waltham Forest, an outer London borough with high levels of deprivation and diversity. In response to these drivers and needs, we describe out ‘stepped care‘ model of four levels of support aimed at strengthening delivery of responsive and adaptive mental health services predominately in the primary care setting. Finally we relate our progress with regards to implementation of the model.