A GP-Led health system for diabetes care: A patient-centered structure or a systemic constraint?

Modern diabetes care faces increasing clinical and technological complexity. While generalist-led models are widely promoted for continuity and accessibility, they may fall short in addressing the nuanced needs of patients with diabetes, particularly in complex or rapidly evolving clinical contexts. The aim of the article is to critically evaluate whether general practitioner (GP)-led models of diabetes care adequately meet patient needs and to explore the role of specialist access within contemporary health systems. A narrative and conceptual analysis of current literature was applied, focusing on patient-centered care, equity, and the organization of diabetes services. Patient-centeredness and equity should underpin diabetes care, including individualized goal setting and shared decision-making. However, overreliance on generalist-led care may contribute to delays, suboptimal care, and reduced clinical precision in complex cases. Open access to specialist care may enhance patient autonomy and enable more timely, comprehensive, and personalized management. At the same time, general practitioners remain essential for holistic care, coordination, and long-term patient engagement. Integrating specialists within primary care through hybrid or collaborative models may combine the strengths of generalists and specialists and improve outcomes, while maintaining equity. Strategic policy initiatives, workforce planning, and technological innovation are necessary to sustainably expand access.