This study is based on interviews with 25 programme leaders at two universities in England. Programme leadership is ubiquitous and essential to effective university operations, yet there is surprisingly little research on the role. It is an ambiguous and complex form of leadership, existing as it does in the space between standard academic and manager profiles. Existing literature on other leadership roles highlights such ambiguity as a major source of stress and cause of inefficiency. Drawing from the perspectives of current programme leaders, four main areas of difficulty are identified: role confusion, the management of others, the status and demands of leadership, and bureaucratic burdens. The paper suggests that the role of programme leader should be taken more seriously at both a research and institutional level, and that sufficient support should be implemented in relation to the four challenges mentioned above. Any real engagement with leadership at programme level, however, should also take into account the micro-politics of institutional management, a politics that combines issues of values, status and identity with more prosaic concerns over role definition, workload and student support.