Executive summary The aim of the study was to analyse stakeholders’ perceptions of the benefits and risks of joint NHS/HE procurement activities in the area of e-content and on this basis identify potential strategies and quick wins. The objectives were to: 1. Assess the organizational and technical structures for joint activities 2. Identify common interests in terms of content, functionality and licensing terms 3. Identify areas of duplication of licensing of e-content 4. Map stakeholders’ needs, priorities, current activity and timetables The key messages are: NHS and HE both spend large and growing sums of money on e-content. Although aligning activity across complex and changing sets of institutions such as these is difficult, there are some examples of successful collaborative initiatives (such as the London Medical Schools group, and the NHS Scotland e-Library). There are common interests in functionality/interfaces, promoting open access, and working on better metrics for estimating usage that might contribute to discussions with publishers over the licence terms. There are differences in the type of resource each might deem core. There is a concern among NHS librarians about loss or lack of access to core content for them, resulting in unwillingness to abandon print resources. In this context, three possible paths for cooperative activity were identified: • sharing information and joint advocacy • building the technical infrastructure • joint procurement. The first, low risk strategy could focus on sharing market intelligence and information about suppliers, on campaigning for improved licence conditions and usage statistics and /or advocacy of open archiving. Another area of collaborative activity could be around the technical infrastructure given that this is more directly under the parties’ control and there has been success in the past, such as convergence around Athens. An inherently more risky but potentially fruitful direction would be towards cooperative procurement activities,. Procurement activities could take place at national, regional or local level and would be likely to focus on certain specific types of content e.g. around e-books. Considering these options produced a set of 12 possible paths of action, for each of which a use case is developed clarifying the goal, the parties to be involved, choices to be made, risks to be managed, criteria of success for the process. Recommendations Recommended actions provide specific examples of activity to support these paths 1) immediate ‘task and finish’ activities aimed at informing current procurement; 2) developing infrastructures to inform open access initiatives across the NHS and HE; and 3) strategic support initiatives to ensure that e-resources are exploited cost-effectively Immediate activities include: • Sharing information and joint advocacy on resources to support health services research, clinical medical research (particularly in clinical genetics, health engineering, cancer, tissue engineering), public health and some of the smaller health specialist disciplines. Some mapping of resources required by the NLH Specialist Libraries to resources that are, or could be offered through Core Content has been done, and this work could be extended to other areas.