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Background <p>Primary care (PC) is increasingly expected to ensure coordination, continuity, and system efficiency in response to population ageing, multimorbidity, and workforce shortages. However, PC is delivered through diverse organisational models, and evidence on how these models relate to the internal capacity of practices to coordinate care remains limited. This study analyses how organisational models of general practice shape the internal capacity of PC and its ability to coordinate care, using the Czech Republic (CR) as a case.</p> Methods <p>The study used a sequential explanatory survey design with a subsequent interpretative expert consultation stage. A cross-sectional online survey of general practitioners (GPs) providing care to adult patients (<i>n</i> = 356) examined organisational models, workforce capacity, task delegation, and care coordination. Descriptive statistical methods were used. Written expert responses to a structured summary of preliminary survey findings were used to contextualise and interpret the observed patterns.</p> Results <p>Organisational models were associated with differences in workforce capacity, administrative support, patient load, and selected coordination-related conditions, while task distribution patterns were broadly similar across practice types.The predominance of small, professionally autonomous practices was associated with limited involvement of non-physician staff, constrained delegation, and high administrative workloads. Expert consultation suggested that these constraints were particularly pronounced in rural settings. Younger physicians were more likely to work in group-based or employment-oriented arrangements, indicating a mismatch between prevailing organisational models and workforce preferences. Limited diagnostic access and weakly institutionalised gatekeeping were further associated with lower coordination capacity.</p> Conclusions <p>Organisational models appear to play an important role in shaping the internal capacity of PC and its ability to coordinate care. The findings suggest that limitations in delegation and coordination reflect the interaction between practice-level organisational characteristics and broader institutional conditions, and are not fully explained by individual provider choices alone.</p> Trial registration <p>Not applicable.</p>

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Organisational models of general practice and internal capacity for care coordination: a mixed-methods study from the Czech Republic

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月3日

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  • Kateřina Heková,
  • Martina Caithamlová,
  • Zuzana Kotherová

摘要

Background

Primary care (PC) is increasingly expected to ensure coordination, continuity, and system efficiency in response to population ageing, multimorbidity, and workforce shortages. However, PC is delivered through diverse organisational models, and evidence on how these models relate to the internal capacity of practices to coordinate care remains limited. This study analyses how organisational models of general practice shape the internal capacity of PC and its ability to coordinate care, using the Czech Republic (CR) as a case.

Methods

The study used a sequential explanatory survey design with a subsequent interpretative expert consultation stage. A cross-sectional online survey of general practitioners (GPs) providing care to adult patients (n = 356) examined organisational models, workforce capacity, task delegation, and care coordination. Descriptive statistical methods were used. Written expert responses to a structured summary of preliminary survey findings were used to contextualise and interpret the observed patterns.

Results

Organisational models were associated with differences in workforce capacity, administrative support, patient load, and selected coordination-related conditions, while task distribution patterns were broadly similar across practice types.The predominance of small, professionally autonomous practices was associated with limited involvement of non-physician staff, constrained delegation, and high administrative workloads. Expert consultation suggested that these constraints were particularly pronounced in rural settings. Younger physicians were more likely to work in group-based or employment-oriented arrangements, indicating a mismatch between prevailing organisational models and workforce preferences. Limited diagnostic access and weakly institutionalised gatekeeping were further associated with lower coordination capacity.

Conclusions

Organisational models appear to play an important role in shaping the internal capacity of PC and its ability to coordinate care. The findings suggest that limitations in delegation and coordination reflect the interaction between practice-level organisational characteristics and broader institutional conditions, and are not fully explained by individual provider choices alone.

Trial registration

Not applicable.