This a pivotal time in his premiership - with the economy on a knife-edge and growing rebellion within the Conservative ranks - and he finds his comms team in upheaval.
Earlier this year he lost strategy guru Steve Hilton, who moved to America. This week, executive director of government comms, Jenny Grey, leaves to join Citigroup and it emerges that fellow civil servant and Downing Street spokesman, Steve Field, is departing to join the IMF. Finally, long-time personal spokeswoman Gabby Bertin will go on maternity leave towards the end of the year.
This is far from ideal for Cameron, whose great strength - ever since he challenged for the leadership of his party - has been his natural ability to communicate with the public.
In Britain this is no mean feat, because the odds are stacked against politicians. This was brought home to me last week during a business trip to New York. Across 'the pond' the presidential election candidates have a superior opportunity to talk directly to their electorate.
At last week's Democratic National Convention, President Obama's keynote speech was screened live, at peak viewing time, on virtually every network TV channel. The same could be said of his wife Michelle's speech on Tuesday evening and even Bill Clinton's speech on Wednesday.
In the offices and restaurants of New York City everyone is talking about the previous night's speech.
This is a different level of political engagement to Britain, where party conference speeches take place mid-afternoon. If we are lucky, we get a few sound bites on the evening news, with more time allocated to a political editor's opinion of what they think the leader was trying to achieve.
Of course American politics suffers from its own problems, but we should envy the higher level of engagement between senior politicians and the man on the street.
For Cameron, the next few months will determine the success or failure of his project, or indeed whether he even had a coherent project in the first place. He will need convince not only his party, but the British electorate, that he has a compelling economic and social vision for a nation in flux.
For this endeavour he will need to optimise every comms channel available, and most importantly, have a stable, trusted and gifted comms team at his side.
Danny Rogers is PRWeek's editor-in-chief.