The Smoke Free North East Office (SFNEO) is the first dedicated tobacco control office in the UK coordinating a regional tobacco control network, Smoke Free North East (SFNE). On the basis of ethnographic research conducted between 2006 and 2008, this article examines the context for SFNEO's emergence at this time and in this region of England, and the main policy and practice challenges it has faced in its early years. SFNE formed in a favourable political and cultural climate, although regional champions were crucial in setting it up. It has worked well in branding itself and in taking advantage of the opportunity to lobby in support of comprehensive smoke-free legislation, although the success of the legislation presents a risk that people will regard SFNE's work as finished. There is a need for independent sustainable funding, strong partnership working and the 'bringing together' of existing organizations under its leadership for an organization such as SFNE to succeed. SFNE offers a model that is transferable to other places as well as to other public health concerns such as alcohol, and has been taken up by public health planners and policy makers with alacrity. This indicates a general perception that SFNE plays an effective role in public health delivery.