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This paper examines leadership in practice, specifically the interaction of leaders and followers, taking account of context (Spillane, J.P. (2006). Distributed Leadership. San Francisco, CA: Jossey Bass). Employing Gronn's dimensions of concertive action and conjoint agency (Gronn, P. (2002). Distributed leadership as a unit of analysis. Leadership Quarterly, 13, pp. 423–451), different conceptualizations of distributed leadership (DL) are examined, and the influence of a health and social care context on attempts to enact DL is analysed. In so doing, boundary conditions or the limits to distributing leadership in health and social care are identified. The analysis suggests that the collective leadership DL model presented by Denis et al. (Denis, J.-L., Lamothe, L. and Langley, A. (2001). The dynamics of collective leadership and strategic change in pluralistic organizations. Academy of Management Journal, 44, pp. 809–837) is most likely to be enacted in the face of policy and professional pressures towards more concentrated leadership. However, where DL does not encompass conjoint agency, it will tend towards more towards ‘nobody in charge’ (Buchanan, D.A., Addicott, R., Fitzgerald, L., Ferlie, E. and Baeza, J.I. (2007). Nobody in charge: distributed change agency in healthcare. Human Relations, 60, pp. 1065–1090) or collaborative leadership (Huxham, C. and Vangen, S. (2000). Leadership in the shaping and implementation of collaboration agendas: how things happen in a (not quite) joined-up world. Academy of Management Journal, 43, pp. 1159–1175). Following the analysis, the authors argue that researchers need to move beyond a reified concept of DL, and ask a more straightforward question of how power is distributed. As Gosling et al. suggest (Gosling, J., Bolden, R. and Petrov, G. (2009). Distributed leadership in higher education: what does it accomplish? Leadership, 5, pp. 299–310), DL evokes an aspiration for the way leadership is configured, and draws attention to iterative relations between leadership, followership and context, but it is a conception of leadership that requires unpacking. This conceptual analysis, applied to health and social care, is offered in pursuit of this aim.