Managed clinical networks for neonatal care were established in England from 2004. Their structure and effectiveness varies widely over the country. Changes in medical manpower and the scarcity of neonatal nurses make the move towards networks urgent, but there is little evidence of a coordinated approach to improving capacity in the tertiary centres, who will have to absorb the activity that follows reconfiguration. Changes in the governance of hospitals, NHS authority boundaries and in commissioning specialist services, with the drive towards reducing health costs, places the process at some considerable risk. Despite these challenges, the development of coordinated clinical networks will be an important force in improving outcome for very preterm babies in the UK. The development of some form of national coordination of network activities and greater sharing of good practice would enhance the value of the managed clinical neonatal networks.