National Health Service (NHS) Trusts are struggling to determine a long‐term strategic direction for their organizations in response to the competitive pressures generated by the NHS reforms. The development of long‐term strategic direction and the methods to implement them are presenting real challenges to the Trusts which have inherited service configurations based on bureaucratic planning frameworks rather than service configurations suited to a more competitive environment. Examines the strategic choices available to these organizations; explores the importance of identifying positive strategic choices; and discusses the advantages and disadvantages in the context of the NHS internal market.
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