The recent introduction and successful application of Lean Thinking in health is generating a belief that continuous improvement (a product of Lean) can be delivered in the context of health care, as long as key organisational principles are in place. This paper offers case studies to illustrate where Lean methods are being introduced into a primary care commissioning organisation and are delivering, as part of an integrated organisational approach that embraces Lean principles and improvement in the patient experience and eliminates the potential for error in patient care.