This case study by South Sefton PCN managing director Rachel Stead, outlines their inspiring Adverse Childhood Experiences (ACEs) Recovery Programme. Rachel reflects on how the conditions were created for something different to develop.
Rachel Stead
The thing that gets people most excited when I talk about our work in South Sefton PCN is the Adverse Childhood Experiences (ACEs) Recovery Programme. It’s a 10-week, group-based programme using the Rockpool Toolkit to help people understand the impact of early-life experiences on their health, relationships and behaviours – particularly coping strategies, self-esteem, and resilience. For many participants, it’s life changing.
We’ve seen people abstain from alcohol where previous rehabilitation hadn’t worked. Others have moved into employment or volunteering, returned to education, taken up physical activity, stopped smoking, and reduced their reliance on medication. Colleagues in NHS Talking Therapies say patients who complete ACEs engage better and achieve improved outcomes.
It’s a brilliant programme. But it isn’t what I planned.
Creating the Conditions for Something Different
I originally applied to the Complete Care Communities Programme (CCCP), which was designed to tackle health inequalities; and for us the start of our neighbourhood health journey. It came with a relatively small amount of funding, but something much more valuable: freedom to innovate.
There were no KPI frameworks, or rigid outcomes, just a commitment to try something, stay connected, and learn. There wasn’t a penalty for getting things wrong. That experience shaped my approach to innovation in primary care.
Three things stand out:
- It takes time
- The freedom to fail enables innovation
- Simplicity matters
It takes time
I started in my role in March 2021, while general practice was still focused on the Covid-19 vaccination programme. Our Clinical Director protected my time – although it felt uncomfortable then, as everyone was so busy but it proved invaluable. I had time to read, to think, and to reflect.
When we started out with CCCP, I was reminded of that. We knew the scale of deprivation in some of our neighbourhoods and its impact, but not what more we could do upstream.
Progress felt slow. I’d develop an idea, test it, refine it—then realise there was someone else we needed to involve. The cycle repeated, reflecting both the complexity of the challenge and the number of people committed to solving it. Coming from the private sector, this felt frustrating.
In hindsight, it was exactly what was needed. We were building relationships, testing ideas, and reshaping our thinking. That’s how we found ACEs, through a Local Authority connection, which proved to be the right solution, and allowing us to adopt a whole neighbourhood approach.
Freedom to Fail
In primary care, we are used to being paid for success – QOF, local contracts, enhanced services. Either we succeed, or we don’t get paid. That creates a system where failure carries real financial risk – and that limits innovation.
What was transformational about the CCCP was the freedom to fail. We monitored risk, captured learning, and reflected regularly, but there was no penalty for trying something that didn’t work. There was an understanding that learning from failure still leads to improvement. That created a sense of freedom that was liberating.
It meant we could test ideas, adapt quickly, and improve as we went. Supportive challenge and critical friends helped refined our thinking and led to a much stronger service.
It’s an approach I’ve tried to hold on to. We now use a “fail fast” mindset, loosely based on Plan–Do–Study–Act cycles. Rather than over-designing, we test small pilots. For example, starting with a single community health event rather than committing to a series, defining success in advance, gathering feedback, and deciding what to do next. It’s simple and pragmatic, allowing us to learn quickly without overcommitting resources.
Keep It Simple
My first service idea was so complicated it was undeliverable, and impossible to explain clearly. I wasn’t alone in this. At one of our CCCP action learning sets, it became obvious: if you can’t explain it in one or two sentences, it’s too complicated.
We moved from a complex, hard-to-visualise idea to something much clearer: People with multiple adverse childhood experiences are more likely to experience poor health outcomes, including mental illness, addiction, and reduced life expectancy. The ACEs programme helps people understand these experiences, build resilience, develop healthier coping strategies, and strengthen relationships.
Being able to say what we were doing in two sentences meant anyone could understand. It’s why the most common pathway for ACEs is now self-referral.
Final thought
Looking back, ACEs wasn’t the starting point—but it was the outcome.
We got there because we had time to think, freedom to test and fail, and the discipline to simplify. The real lesson isn’t designing the perfect service—it’s creating the conditions to develop something meaningful by listening, reflecting, adapting, and working with others.
And that, ultimately, is what neighbourhood health is about: not delivering solutions in isolation, but building relationships, understanding communities, and working together to create something that genuinely meets local need.
