This chapter describes the experiences of the newly created role of jointly appointed Directors of Public Health (DPH). It provides pointers from experience of what will make the posts work better and describes some of the challenges faced. Several local authorities (LAs) and primary care trusts (PCTs) across the country have appointed a joint DPH. In their most developed form these posts are jointly funded; the DPH is an executive director of the LA and a board member of the PCT. The chapter briefly considers the historical context of the relationship between local government and health services before posing the question: what is the added value of going for a joint DPH post? The national and local drivers for change will be reviewed and the structures and processes needed to set up a joint post outlined. The potential problems associated with joint posts are described along with suggested solutions.