Purpose - Healthcare organisations face significant productivity pressures and are undergoing major service transformation. The purpose of this paper is to disseminate findings from a Lean healthcare project using a National Health Service Single Point of Access environment as the case study. It demonstrates the relevance and extent that Lean can be applied to this type of healthcare service setting. Design/methodology/approach - Action research was applied and Lean tools used to establish current state processes, identify wastes and develop service improvement opportunities based upon defined customer values. Findings - The quality of referral information was found to be the root cause of a number of process wastes and causes of failure for the service. Recognising the relationship and the nature of interaction with the service's customer/supplier lead to more effective and sustainable service improvement opportunities and the co-creation of value. It was also recognised that not all the Lean principles could be applied to this type of healthcare setting. Practical implications - The study is useful to organisations using Lean to undertake service improvement activities. The paper outlines how extending the value stream beyond the organisation to include suppliers can lead to improved co-production and generation of service value. Originality/value - The study contributes to service productivity research by demonstrating the relevance and limitations of Lean application in a new healthcare service setting. The case study demonstrates the practical challenges of implementing Lean in reciprocal service design models and adds validity to existing contextual models.