This paper reports on the contribution made by the first cohort of Primary Care Graduate Mental Health Workers (PCGMHW) employed in the Southwest of England. The PCGMHW is one of the new roles envisaged as part of the NHS plan. Aimed at enabling quick access to a range of time-limited therapies, while at the same time engaging in public health strategies to promote mental health in communities, the PCGMHW is at the cutting edge of modernizing primary care mental health. This study demonstrated that PCGMHWs trained in time-limited therapy approaches such as facilitated self-help moved quickly into situations were they were treating people with mild to moderate mental health problems, with evidence of clinical effectiveness. However, the community development aspect of the role was slower to develop, possibly as a reflection of the preference for one to one work in mental health or, alternatively, as an indication of the nebulous nature of public health work. The study identifies a number of key areas for consideration. First is the role of the PCGMHW in signposting people to services or resources. Second, the role of referral protocols in developing service models that profit from the presence of PCGMHWs. Third, the need to develop the role in relation to public health, stigma and social exclusion. However, to achieve this greater clarity over the role is required in Primary Care Trusts and urgent consideration of continuing professional development needs of PCGMHWs.