Aim: To evaluate whether structured, nurse-led pro-active care of patients with chronic depression in primary care improves outcomes. Methods: Participants with chronic/recurrent major depression or dysthymia were recruited from 42 UK general practices and randomised to GP treatment as usual or nurse intervention over 2 years. Results: 282 people received the intervention with 276 controls. At 24 months there was no significant improvement in Beck Depression Inventory (BDI-II) score or quality of life (Euroquol-EQ-VAS), but a significant improvement in functional impairment (Work and Social Activity Schedule) of 2.5(95% CI:0.6,4.3, p=0.010) in intervention patients. Impact per practice nurse intervention session was -0.37(95% CI:-0.68,-0.07,p=0.017) on BDI-II and -0.33(95% CI:-0.55,-0.10,p=0.004) on WSAS scores, indicating that attending all 10 intervention sessions could lead to a BDI-II score reduction of 3.7 points compared to controls. Conclusion: The intervention improved functioning in these patients, the majority of whom had complex long-term difficulties, but only had a significant impact on depressive symptoms in those engaging with the full intervention. Declaration of interest: None