Despite variation across national contexts, university-clinical partners in any country have similar aims. These are to deliver world-class research, education and health care services, and there are similar tensions.. Health and higher education partners face two central paradoxes: that they are interdependent (require each other to discharge their mission) and independent (managed according to different priorities). Also, partners struggle to balance the demands of two masters (health and education) whose priorities are difficult to square. Traditional ways of organising partnerships are challenged everywhere by the global change in clinical provision, education and research. Despite pressures on its organisational form, the tripartite mission remains a vital pursuit. The way it is achieved needs to be re-examined. Introducing evidence-based practice and service innovation, translating research into practice, managing a growing knowledge base, and developing new forms of working each require a tripartite approach. Partnerships are not necessarily focused on synergy between missions, meaning the integration of component parts to produce an effect that is greater than the sum of its parts. This report draws on discussions with leaders of organisations at the interface of health and university sectors on the current and future direction of relationships between service, research and education. It outlines some challenges for those managing the tripartite mission and suggestions for ways to approach these.