Paramedics in an emerging role; a reflexive thematic analysis of barriers and enablers to primary care innovation through a community of practice

BACKGROUND: Community paramedicine is an emerging model of care that focuses on preventative and rehabilitative health and improves equitable access to primary care. Four community health services in rural and regional Victoria, Australia, implemented the evidence-based Canadian CP@clinic (Community Paramedicine at Clinic) program. The paramedic-led program delivers free drop-in clinics with chronic disease screening, onward referrals, care navigation and health education. METHODS: We conducted a reflexive thematic analysis of de-identified monthly meeting records of 13 CoP meetings. Analysis specifically focussed on the barriers and enablers of program delivery and on how the CoP supported CP@clinic program administrators, researchers and community paramedics. RESULTS: CP@clinic implementation in rural, regional and remote Australia was shaped by four interrelated themes: workforce development, community engagement, data collection and program sustainability. Barriers centred on role ambiguity and transition from emergency care, the time intensity of trust-building within communities and referral navigation, administrative burden compounded by digital infrastructure constraints and persistent funding and workforce instability. Within these dynamics the CoP emerged as a crucial implementation mechanism that enabled both individual practitioners and organisations to navigate uncertainties, build capacity and maintain program adherence. CONCLUSION: CP@clinic can take root in rural, regional and remote Australia but only if the conditions are right. The CoP acted as the engine room for implementation accelerating role transition, local adaptation and practical problem solving. Yet persistent barriers - role ambiguity, time-intensive trust building, heavy data demands in low-connectivity settings and funding instability - continue to stall momentum. To move from a promising pilot to durable system change, the CP@clinic program needs CoP-enabled learning along with structural investment in training, digital infrastructure, evaluation support and long-term funding.