Transforming primary care: funding and governance in the shift from physician-centred models to interprofessional teams - a scoping review

Primary care systems in high-income countries are undergoing transformation to meet rising healthcare demands, control costs and improve outcomes in ageing populations. While overarching goals are well articulated, the practical steps and governance mechanisms required to implement these reforms - particularly shifts from general practitioner-centred to interprofessional team-based models - remain poorly understood.

This scoping review investigated how governance and funding models supporting and maintaining primary care transformation have been implemented in high-income countries. It identified key reform steps, explored barriers and facilitators, and analysed successful models across system (macro) and practice levels.

A scoping review was conducted using international literature from high-income countries, including grey literature. Titles (n = 1586) and full texts (n = 358) were screened by two reviewers. Data were extracted from 90 eligible studies, selected for contextual comparability, reform maturity and implementation continuity. Included sources span policy documents, academic studies and comparative analyses.

The review mapped five new primary care models across four countries (US, Canada, Netherlands, France), supplemented by data from Belgium and Australia. Reform initiatives typically began in the mid-2000s and are still ongoing. Common features include: a shift from fee-for-service to blended or value-based payments (capitation, bonuses); the development of interprofessional teams with salaried non-physician members; introduction of shared leadership, clear role definitions and electronic health record (EHR)-linked incentives. Models vary widely: for example, the US Patient-Centered Medical Homes involve multipayer systems with fee-for-service plus bonuses. Ontario's Family Health Teams use capitation and public funding, while Quebec remains fee-for-service-heavy, with teams initially restricted to nurses. The Netherlands and France implemented mixed top-down and bottom-up strategies, with regionally organised care groups and advanced EHR infrastructure. Despite policy support, interprofessional primary care team implementation is hampered by physician dominance, insufficient EHR integration and fragmented accountability. Only a minority of reforms have undergone systematic evaluation, and long-term sustainability remains uncertain.

Blended top-down and bottom-up approaches appear most effective for primary care transformation, offering consistency in implementation and local flexibility. Effective reforms combine blended payment models, strong EHR systems and interprofessional training. Physician engagement and a balanced approach to accountability are essential. Future priorities include mixed funding, rigorous evaluation of the effects on healthcare access and quality, team cohesion, cost control and supportive governance at both policy and practice levels. A widely agreed conceptual framework will be helpful for designing and implementing evaluations and cross-national comparisons.