In-line coagulation adsorption (ILCA) followed by ceramic microfiltration (CMF) was tested at pilot scale and compared to a full scale traditional process consisting of coagulation and dissolved air flotation (DAF) followed by rapid gravity sand filtration (RGF), for treating a reservoir water source which is prone to high concentrations of algae. The ILCA CMF process was shown to remove 10–16% more dissolved organic carbon and reduced disinfection by-product formation potential (DBPFP) by 9–13% in comparison to conventional treatment (optimised coagulation). ILCA effectively controlled membrane fouling allowing the ceramic membranes to be operated at high flux (200 l/m2h) with low membrane fouling (0.9–1.9 kPa/day). A process comprising ILCA and direct ceramic microfiltration was shown to provide very stable treated water quality under a range of challenging conditions. Additionally, the process is more compact showing significant reductions (circa 60%) in footprint relative to a conventional DAF/RGF process.