Aims This paper reports the evidence base and expert opinion on the abilities and organisational development needs of primary care trusts (PCTs) to commission mental health services. Methods Thirteen papers or reports relevant to the research aims were identified through the search strategy and twelve senior health service managers, clinicians and users (71% of those approached) agreed to the telephone interview. Results The evidence base on commissioning identified five key barriers to effective commissioning from a PCT perspective, including a lack of resources particularly time and money, staff training needs, a lack of priority for mental health and commissioning at the grass roots level, issues around effective partnership working and the need for strong and informed leadership. The evidence base also identified four key areas that PCTs need to address if they are to be fit for purpose in comIntroduction missioning mental health services including infrastructure changes, a skills training programme, mechanisms to encourage greater partnership working and a development programme that includes the new primary care mental health workforce. Conclusions Although the evidence base suggests there are a number of barriers to overcome to achieve good quality PCT commissioning of mental health, many experts in the field are positive about the capacity and capability of PCTs to address the commissioning agenda and see it as an opportunity rather than a threat. PCTs now have the ability to commission locally focused and user-centred services that could lead to improved quality of life for a traditionally socially excluded sector of society.