Aim: This study takes a unique approach to understanding the implementation of a whole-system place-based strategy to improve health and reduce health inequalities, using ambidextrous organisational theory. Methods: The data consisted of the secondary analysis of 23 strategy documents in one local authority, and interviews (n = 22) with local decision-makers, front-line workers, and service users. Results: Our analysis highlights the tensions inherent in British Local Authorities (LAs), which in times of austerity have increasingly been expected to perform as financially self-sufficient, while meeting their health inequalities targets. Increasingly, LAs can be seen as being characterised by goal incoherence, with competing institutional logics. This leads them to exist in a paradoxical reality, leading to ambiguity and unease in the workforce, which can be reconciled through the generation of creative solutions. Conclusion:
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