Looks at industrial relations developments in the “first wave” of self‐governing trusts in the National Health Service. It finds that many are departing from the NHS′s traditional industrial relations model. There is a move from national to local bargaining and the predominant pattern is single table bargaining, as opposed to separate Whitley Councils for each functional group. In addition, to simplify the complex traditional model, negotiations in many trusts will be carried out effectively by representatives of only some of the staff organizations with members in the trust. Moreover unitarist exceptions to this still essentially pluralist pattern can be found in trusts, with examples of no union recognition, a single union deal and pay deals unilaterally determined by management.