Practice development can be a local initiative, or it can be shaped by ‘top-down’ policy agendas. Following the launch of a National Service Framework for Older People (NSF-OP) in England, a study was commissioned to examine the development of specialist services and staff for older people, one of the key recommendations of this policy. A two stage study was conducted, the first stage being a questionnaire in three parts to identify practice developments across a range of agencies, and the second to carry out case studies to identify processes in more detail. This paper reports on some of the findings from the first stage of the study, focusing on the data from National Health Services. This suggested that definitions of specialism are unclear and roles are ambiguous, which has implications for training and practice development. Other data, however, suggested that the development of services for older people was not simply a response to the NSF-OP, but had been in progress for variable lengths of time before this.