Patients with severe mental illness (SMI) are some of the most stigmatised, disadvantaged and vulnerable in society. Integral to the Core20Plus5 inequalities drive, their life expectancy is curtailed by 15-20 years due to stigma, cardiovascular morbidity and anti-psychotic use. Equally, they can be a challenge to case-find and care for on a practical level. In this lecture we explore some of the key challenges, possible solutions and highlight elements of good practice. We will also explore elements of the SMI physical health check, NICE guidance and building a resilient primary care MH workforce.