Understanding the context a co-production project is to be conducted in is key and can include prioritising limited resources to meet health needs, something of a particular challenge in areas like the North East of England where health outcomes remain stubbornly lower than the England average and where there is substantial (perceived or actual) unmet heath needs. There is much to consider with regard to how interventions are evaluated to demonstrate adding value to the local system without the requirement for a randomised control trial.