Nursing, in common with all healthcare disciplines, has had to respond to major developments in the wider context of health care. Shifts in government policy, changing preferences for the location of health care, over-stretched resources and new developments in medical technologies have all had a considerable impact on the modes of healthcare delivery, including nursing care. In times of rapid change, new healthcare roles emerge, others are reconstructed and some decline, as happened when fever nursing became obsolete owing to improvements in health care and living conditions during the first half of the twentieth century (Currie 1997). Over the past two decades, some nursing disciplines have expanded considerably – especially those based in the community – and specialist nursing roles in areas such as infection control, continence care, palliative care, psychotherapy, tissue viability and pain management have become commonplace. This article examines some of the implications of the ‘new NHS’ for practice nurses and community mental health nurses (CMHNs).