Purpose: The purpose of this article is to review the use of competence frameworks in the UK healthcare sector and to explore characteristics of the sector that may influence the success of projects to develop new frameworks. Design/methodology/approach: The paper draws on project reports and evaluations of practice in a range of recent projects to develop new competence frameworks. Findings: There are a number of competence frameworks in use in the UK healthcare sector, principally the NHS, designed for a range of purposes. There are many potential benefits of such frameworks. The main characteristics of the UK healthcare sector that can present difficulties to the development, and ultimate use, of such competence frameworks are the size, complexity, professionalisation and extent of other simultaneous change in the sector. Potential difficulties caused by these characteristics can be ameliorated by measures to align the development of the framework with priorities, interests and concerns of practitioners and stakeholder bodies. A case study of effective implementation of a framework demonstrates the benefits of integrating the competences with other measures to deliver a new service. Practical implications: The paper gives practical guidance for those who intend to develop and implement competence frameworks in healthcare and other complex environments. Originality/value: The paper applies established organisational change concepts to the specific issue of developing new frameworks of competence. The article provides high originality and high value to those who commission and those who develop competence frameworks. (Contains 1 table and 1 note.)