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The paper aims to take a reflective stance on the relationship between policy/evidence and practice, which, the authors argue, is conceptually under‐developed. The paper aims to show that current research perspectives fail to frame evidence and policy in relation to practice.

A qualitative study was conducted in the English NHS in four Primary Care Trusts (PCTs). Seventy‐five observations of meetings and 52 semi‐structured interviews were completed. The approach to data analysis was to explore and reconstruct narratives of PCT managers' real practices.

The exploratory findings are presented through two kinds of narratives. The first narrative vividly illustrates the significance of the active involvement, skills and creativity of health care practitioners for policy implementation. The second narrative elucidates how problems of collaboration among different experts in PCTs might emerge and affect evidence utilisation in practice.

The findings exemplify that policies are made workable in practice and, hence, policy makers may also need to be mindful of practical intricacies and conceive policy implementation as an iterative process.

The contribution of this paper lies in offering an alternative and important perspective to the debate of utilisation of policy/evidence in health care management and in advancing existing understanding of health care management practice. The paper's rich empirical examples demonstrate some important dimensions of the complexity of practice.