This paper presents a thematic analysis of 176 interview transcripts from front line staff working during the first wave of COVID-19 in the East of England. Methods Presented as a descriptive case study it reflects the complexity and numerous variables that influenced staff experiences of delivering care and support across the health and social care system between April and August 2020. Drawing upon the methodology of realist synthesis, it addresses the question “ What works for whom and in what contexts and why ?” to help illuminate real-world issues that people have faced. Results Thirty-one themes were distilled highlighting lessons learned from things that went well compared with those that did not; challenges compared with the celebrations and outcomes; learning and insights gained; impact on role; and system headlines. Four tentative theories of system transformation are presented to highlight support mechanisms that are needed to enable front line teams to be effective in further waves of the pandemic, capitalising on system wide learning, patient, resident and staff wellbeing. Conclusions This paper presents a unique insight into front line staff experiences of working during the first wave of the Covid-19 pandemic using realist synthesis methods to distil key themes and tentative theories about what strategies work to enable and empower front line teams to be effective and to support system wide learning and transformation.