In an era of world class commissioning, NHS commissioners are seen as the leaders of the health care system, responsible for driving service change and improving outcomes for patients and local people. However, to be truly effective, this role requires an understanding of healthcare delivery and of the levers and approaches necessary to support changes in practice within front-line services. In response, this module outlines the concepts, tools and skills required to understand pathways and business processes in healthcare, work effectively with service providers, maximise the workforce contribution, facilitate greater clinical engagement and support provider collaboration.