In this article we discuss the findings from a recent study of UK policy and practice in relation to sexual health services for young people, based in--or closely linked with--schools. This study formed part of a larger project, completed in 2009, which also included a systematic review of international research. The findings discussed in this paper are based on analyses of interviews with 51 service managers and questionnaire returns from 205 school nurses. Four themes are discussed. First, we found three main service permutations, in a context of very diverse and uneven implementation. Second, we identified factors within the school context that shaped and often constrained service provision; some of these also have implications for sex and relationships education (SRE). Third, we found contrasting approaches to the relationship between SRE input and sexual health provision. Fourth, we identified some specific barriers that need to be addressed in order to develop "young people friendly" services in the school context. The relative autonomy available to school head teachers and governors can represent an obstacle to service provision--and inter-professional collaboration--in a climate where, in many schools, there is still considerable ambivalence about discussing "sex" openly. In conclusion, we identify areas worthy of further research and development, in order to address some obstacles to sexual health service and SRE provision in schools. (Contains 1 table.)