Table 4 Considerations for co-design

1. Consider how best to connect with communities

Partnering with well-respected local voluntary organisations, commissioning private companies, or using in-house resources to build relationship are all options, each with their own advantages and disadvantages.

2. Spend time with partners developing shared values

Spend time early on discussing with potential partners your values, building a shared vision for co-design and what you hope to achieve.

3. Build strong relationships

Establishing trust, rapport and credibility with communities is an essential part of co-design: it will take time and cannot be rushed. This may be especially true with traditionally under-served populations.

4. Get comfortable with uncertainty

Co-design inherently involves a level of uncertainty as stakeholders may view issues in different ways. Co-design should focus on outcomes deemed most important to community members.

5. Reflect on commissioning approaches

Traditional commissioning approaches may not fit easily with co-design. Consider how you might commission for service (to produce longer-term ‘value’) rather than the service (focusing on short-term, pre-specified outcomes).

6. Think about the long game

Consider the sustainability of the work. Short-term or unreliable funding hinders meaningful co-design and can damage relationships with communities.

7. Build the evidence base

Use evaluation approaches that can adequately capture the often subtle, long-term, and upstream impacts of co-design. Share the successes and the failures.