There is compelling evidence in the literature that anxiety and depression affect high percentages of people with long-term physical conditions and that these often go undiagnosed. This can result in high use of general medical services in people's attempts to have their psychological needs met. This opinion piece explores some of the challenges and implications of this for occupational therapists, who have been educated to work occupationally alongside biological, psychological and sociological factors. It concludes that in a changing National Health Service, occupational therapists need to be able to deliver the true holistic occupational work required by those with long-term conditions, thus meeting biopsychosocial needs. This way, occupational therapists will take into account the complexity of components needed to engage in a variety of activities, and the economic benefits of this return to the profession's philosophy may benefit their standing in the new commissioning climate.

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