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Effective strategic analysis of existing and potential services requires a framework which is relevant and understandable to both clinicians and senior managers. Our work with NHS trusts has developed a framework based on analysis of services into four principal service streams ‐ emergency general hospital, non‐emergency general hospital, specialist general hospital and tertiary. Relating service streams to clinical specialties provides a matrix which can provide a basis for an initial analysis of the current and prospective clinical services portfolio, allowing drilling down into the detail and back up to the overall picture. Portfolio effectiveness is assessed by considering overall viability consisting of three interrelated elements ‐ clinical, market and financial viability. The inter‐relationship of service streams, clinical specialties and viability allows the trust board and key clinicians to share insights into the current and potential systemic linkages between these three elements and to develop a vision of future strategic direction.

The paper explains the principles and approach taken to introduce the general management philosophy into a community unit; and the way in which it has been implemented is also addressed. The paper also demonstrates how a management educator and practising manager have worked together in an action research mode not only to plan the ‘what’ but also the ‘how’.