This paper describes the key strategic challenges facing a purchaser of health care services in central Scotland. The paper describes a number of key issues including influencing the health of the local population, the financial constraints, the development of alliances and the involvement of service users in planning. It highlights the importance of organizational development and the management of the external environment. Long‐term challenges associated with the purchase of health care are suggested and the paper concludes that achieving health status targets and the desires of the local population could well conflict. It suggests that health boards/authorities will need to enhance their planning and developmental work for the futur