Background Emergency Care Practitioners (ECPs) arose from an ambulance-service initiative to provide an alternative response to patients who may not need transporting to hospital. ECPs are recruited from paramedic, nursing, and other clinical backgrounds. They are trained to assess and treat patients with minor or moderate health problems or refer them to an appropriate care provider. ECPs are working in different health care settings (eg, GP out-of-hours, 999 ambulance, and urgent care).

Methods As part of the National Evaluation of Emergency Care Practitioners (NEECaP) Trial, we conducted interviews with 20 ECPs working in five different models of service delivery. The interviews were guided by a semi-structured interview schedule, tape recorded and transcribed. The texts were processed thematically according to the principles of framework analysis for applied policy research.

Results The requirement of the ECP role to work across traditional organisational and professional boundaries raised significant challenges for integration into existing health care teams. Tensions operated at an ‘individual’ and ‘collective’ level. These were attributed to lack of understanding about what ECPs are and what they can do, inter-professional jealousies, protecting self-interest, fear of losing resources, perceived differences in pay, education, qualifications, and in clinical competence. The strategies used by ECPs to smooth their integration can be conceptualised as a combination of military (‘numbers of ECPs on the ground’), (‘behind the lines’) and diplomatic (‘winning hearts and minds’; ‘building relationships’, ‘foreign aid’) actions. However, the experience of reshaping existing teams were also associated with weakening the traditional employer-employee links, and straining relationships between ECPs and those who they had previously regarded as colleagues working for the same organisation (‘feelings of being in no-man's land’).

Conclusions Successful integration of ECPs depends on strategic vision, and effective organisational partnerships at senior management level backed up operationally and supported by clear lines of communication to all stakeholders.