Denominational disputes over theology—particularly ordination of practicing homosexuals as pastors and gay marriage—and bureaucracy led to the founding of ECO.

[6] PC(USA) had faced controversy for years over its liberal theology and disputes over interpretations of the Bible.

[11] In February 2011, a group of pastors issued a white paper that declared the PC(USA) "deathly ill" and called for a new approach.

The Fellowship initiated plans for ECO in response to interest from pastors and congregations for a new Presbyterian denomination.

[19] Reflecting its Reformed heritage, ECO believes that, as a consequence of the Fall of Man, humans lost free will and are incapable of turning towards God.

All church members are to embody the three-fold offices in their daily lives by sharing and enacting the Gospel and extending the lordship of Jesus Christ.

This includes a life of prayer, regular self-examination (especially guided by the Ten Commandments), and sincere confession of sin.

These include:[17] This seems to indicate that the denomination is no longer espousing the Neo-Orthodoxy or the Barthian theology of the Confession of 1967 and the alleged radical feminism enshrined in the Brief Statement of Faith, which became the foundations of the LGBTQ movements in the PC(USA), in their new Confessional Standards.

[27] Full members, or "covenant partners", are able to vote in congregational meetings and hold leadership roles.

To become a covenant partner, a person must make a public profession of faith in Jesus Christ as savior and lord.

Ordained officers vow to "receive, adopt, and be bound by the Essential Tenets" and to be guided by the Confessional Standards.

The synod elects an executive council, which has power to organize presbyteries, settle disputes between them and manage the ongoing operations of the denomination.