As the Medical Director and Deputy Medical Director of the Avon and Wiltshire Mental Health Partnership Trust, we are responsible for the recruitment and development of a large number of medical staff. We are also extensively involved in trying to develop new services in line with the two National Service Frameworks (NSFs), and other central and local directives. Discussion with colleagues elsewhere suggests that we are not alone in experiencing a number of problems, including being hampered by the financial position of our commissioners and the lack of structural protection for mental health funding. However, the task is also made more difficult by the conflicting local and central imperatives from the Royal College of Psychiatrists and the Department of Health. The current problems facing our Trust are outlined as an illustration of the more generally experienced difficulties. Some possible solutions are proposed.
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