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

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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 An explanatory sequential mixed-methods design was applied. 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 and comparative statistical methods were used. Structured expert commentaries were used to contextualise and interpret quantitative findings. Results Organisational models were systematically associated with differences in workforce capacity, task delegation, and care coordination. The predominance of small, professionally autonomous practices was associated with limited involvement of non-physician staff, constrained delegation, and high administrative workloads. Expert commentaries 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 fundamentally shape the internal capacity of PC and its ability to coordinate care. Limitations in delegation and coordination are structurally embedded in prevailing organisational arrangements rather than driven by individual professional choices. Trial registration: Not applicable. Primary care General practice Organisational models Care coordination Internal capacity Task delegation Workforce organisation Czech Republic Background The organisation of PC is central to shaping the effectiveness, coordination, and outcomes of healthcare systems [ 1 , 2 ]. Strengthening PC has therefore become a key strategy for health system reform, reflecting its potential to improve population health while enhancing system efficiency and equity [ 3 , 4 ]. Across Europe, PC systems are facing increasing pressure due to population ageing, the growing burden of chronic and multi-morbid conditions, rising patient expectations, workforce shortages, and the effects of recent crises, including the COVID-19 pandemic [ 5 , 6 ]. These cumulative pressures have intensified efforts to identify how PC should be organised to function effectively under conditions of growing demand and complexity [ 7 ]. In many high-income countries, PC is predominantly delivered through small, professionally autonomous practices, which has important implications for how care is organised and coordinated and can complicate attempts to translate system-level ambitions into routine practice [ 8 ]. At the same time, PC is not organisationally uniform. Across countries, general practice is delivered through a wide range of organisational models that differ in practice size, team composition, and degree of integration, from solo practices to larger, multidisciplinary and collaborative settings [ 9 – 11 ]. Emerging evidence shows that these organisational arrangements are not a neutral backdrop, but actively shape care coordination, workforce dynamics and service delivery, with collaborative and multidisciplinary models associated with more favourable outcomes in some contexts [ 12 , 13 ]. Rather than focusing on specific team-based interventions or predefined care models, this study addresses the organisational conditions that shape what general practice is structurally able to deliver in everyday PC. In this context, internal capacity is conceptualised as an organisational property of general practice, referring to the structural ability of practices to allocate and redistribute tasks, integrate non-physician staff, and sustain coordination functions within existing institutional arrangements [ 9 , 12 ]. Yet, despite growing expectations and increasing policy emphasis on integrated and coordinated PC, empirical evidence on how organisational models of general practice shape internal capacity—particularly with regard to care coordination—remains limited. Therefore, the aim of this study is to analyse how organisational models of general practice shape the internal capacity of PC and its capacity for care coordination. The analysis focuses on empirically observable differences between organisational models with regard to organisational structure, workforce capacity and task delegation, generational patterns among GPs, and the organisation and coordination of care. Methods The analysis presented in this study focuses on the PC system in the CR, characterised by a persistent dominance of small, professionally autonomous general practices alongside growing policy expectations in this sector. PC is delivered by GPs for adults and by GPs for children and adolescents. This study focuses exclusively on GPs providing care to adult patients, who typically operate as self-employed providers contracted within the publicly funded health insurance system. While patient registration with a specific GP is not legally mandatory, access to routine PC is organised through a patient registration system [14]. The current organisational configuration of Czech PC is shaped by a strong path-dependent development linked to the post-socialist transformation of the healthcare system. Prior to 1989, healthcare provision was highly centralised and organised through territorially defined public institutions. The healthcare reforms of the 1990s led to rapid decentralisation and the dissolution of integrated district-based structures, alongside the expansion of independently operating ambulatory providers and a strengthened role of outpatient specialist care [15]. These reforms were accompanied by regulatory arrangements, including restrictions on prescribing and referral practices for GPs, which contributed to a fragmented organisation of care and limited formal integration between levels of the healthcare system. Key structural features established during this transition have persisted into the present system, despite more recent policy efforts aimed at redefining and strengthening the role of GPs within Czech healthcare [16]. National workforce data indicate pronounced demographic ageing among GPs, with a growing share of physicians aged 60 years and older, raising concerns about the sustainability and internal capacity of PC provision [17]. At the same time, international comparative evidence from the OECD Patient-Reported Indicator Surveys (PaRIS) indicates that Czech PC performs relatively strongly on patient-reported measures of continuity and perceived care coordination, while levels of trust in the healthcare system remain below the average of participating EU countries [18]. These system characteristics form the contextual background for the empirical analysis. Study design This study employed a mixed-methods design, combining a cross-sectional quantitative survey with a subsequent qualitative component in the form of expert commentaries to contextualise and interpret the survey findings. Survey and sampling The quantitative component consisted of an online survey targeting GPs for adults. GPs listed in the National Register of Healthcare Providers of the Institute of Health Information and Statistics of the CR were invited to participate [19]. A total of 356 respondents completed the questionnaire (see Additional File 1), representing approximately 6.6% of all GPs in the Czech Republic. At a 5% significance level, the sampling error was below 5.1% for a 50% proportion and 3.0% for a 10% proportion. Participation was voluntary and anonymous. Data collection took place between January and March 2024. The questionnaire included closed-ended (single- and multiple-choice) and open-ended items, primarily requesting numerical responses. It covered organisational models, personnel composition, staff competencies, practice infrastructure, number of registered patients, care organisation, and waiting times for acute and non-acute consultations. For analysis, organisational models were grouped into four categories reflecting differences in organisational structure and employment arrangements: solo, group, network-based, and employed practices. This harmonised classification was used to enhance analytical clarity and international comparability (see Supplementary Figure S1). Solo practices included single-physician practices, regardless of whether they operated independently or within a polyclinic. Group practices comprised two or more GPs, including both formally integrated teams and practices sharing premises without full organisational integration. Network-based practices operated as part of a provider network or chain with shared ownership or management. Employed GPs worked under an employment contract within hospital outpatient departments. Expert commentaries Following the preliminary analysis of the survey data, a qualitative interpretative component was conducted in the form of expert commentaries. The aim of this component was not to generate new empirical categories , but to capture expert perspectives on the observed patterns and to support interpretation of the quantitative results. All experts received the same structured comment template summarising key survey findings (see Additional File 2). The purpose was to obtain contextual, structural, and policy-oriented reflections on the identified patterns rather than to reassess the statistical analysis. Experts were selected based on their professional expertise and standing in PC, including representatives of professional associations of GPs and nurses, as well as representatives of the Ministry of Health. Seven experts (four women and three men) were invited, of whom five provided written responses. Expert input was used to contextualise the quantitative findings and to inform interpretation of structural and workforce-related implications. All participating experts consented to having their professional roles disclosed. An overview of expert characteristics is provided in Table 1. Table 1 List of experts Expert Expert name Expert position 1 Kateřina Javorská General Practitioner; Member of the SVL ČLS JEP Committee 2 Bohumil Seifert Vice President and Scientific Secretary, the SVL ČLS JEP committee 3 Dana Jurásková Former Minister of Health of the Czech Republic 4 Ludmila Bezdíčková Member of the Committee of the Association of General Practitioners of the Czech Republic and the SVL ČLS JEP; Head of the Department of General Practice, IPVZ 5 Jan Přáda Vice President of the Czech Medical Chamber Abbreviations : SVL ČLS JEP = Society of General Practice, Czech Medical Society of Jan Evangelista Purkyně; IPVZ = Institute for Postgraduate Medical Education. Data analysis Survey data were exported from Google Forms and analysed using descriptive and comparative statistical methods. Results were stratified by organisational model, age of the GP, and region. Expert commentaries were analysed using a qualitative interpretative approach. All written responses were read in full and subjected to thematic categorisation focusing on how experts explained, contextualised, or problematised the quantitative findings. Particular attention was paid to areas of convergence and divergence across expert perspectives. The analysis aimed to identify underlying structural explanations rather than to generate new empirical categories. Interpretations were discussed among the authors prior to integration with the survey results. Findings from both components were integrated at the interpretation stage. The study protocol was reviewed and approved by the Ethics Committee of the Faculty of Biomedical Engineering, Czech Technical University in Prague (Approval No. C63/2025) (see Additional File 3). Results Respondent characteristics The survey included 356 GPs for adults. The sample was predominantly female (66.6%). The age distribution was concentrated among middle-aged and older physicians, with a median age of 51 years. The youngest age group (25–30 years) comprised 2.2% of respondents. Participants were recruited from all regions of the CR, with the highest proportions in Prague and the South Moravian Region (see Table 2). The gender distribution closely reflects national workforce data reported by the Ministry of Health [20]. Table 2 Respondent characteristics n % Sex Women 237 66.6 Men 118 33.1 Not reported 1 0.3 Age (years) Median 51.1 25–30 8 2.2 31–40 66 18.5 41–50 103 28.9 51–60 100 28.1 ≥61 79 22.2 Region Capital City of Prague 50 14.0 South Moravian 45 12.6 Central Bohemian 41 11.5 Moravian-Silesian 28 7.9 Ústí nad Labem 26 7.3 South Bohemian 23 6.5 Vysočina 23 6.5 Olomouc 23 6.5 Plzeň 21 5.9 Hradec Králové 20 5.6 Liberec 20 5.6 Zlín 17 4.8 Pardubice 13 3.7 Karlovy Vary 6 1.7 The following sections present findings on organisational models, workforce capacity, task delegation, and care coordination, integrating quantitative results with expert commentary. Organisational fragmentation and professional autonomy as structural characteristics of the system The distribution of organisational models indicates a predominance of solo practices within Czech PC (Table 3). Solo practices represented the predominant model, accounting for approximately 65% of respondents. Of these, 29% were administratively affiliated with a polyclinic or another healthcare facility, while continuing to operate as independent offices. Group and team-based practices accounted for 29.5% of respondents. 3.4% reported employment in network-based practices, and 2% practised as employed GPs. Multidisciplinary organisational arrangements were uncommon in Czech PC. The involvement of physicians from other specialties within the same workplace was reported by 9% of respondents, primarily within traditional polyclinic settings. Table 3 Distribution of respondents by organisational model Solo Group Network-based Employed GPs n 232 105 12 7 % 65.1 29.5 3.4 2.0 Organisational models differed substantially in terms of practice size and staffing capacity. Variation in practice scale and internal workforce resources by organisational model is summarised in Table 4. The mean number of full-time equivalent (FTE) GPs per site was highest in network-based practices (3.5 FTEs) and lowest in solo practices (1.0 FTE). These differences were also reflected in the staffing structure of practices. Overall, the availability of non-physician healthcare personnel was low. The mean ratio of non-physician healthcare personnel to GP FTEs was 1.16. Nearly 70% of practices followed a one-physician–one-non-physician staffing model (most frequently in solo practices and least frequently among employed GPs). Fewer than 25% of practices employed more than 1 non-physician healthcare personnel (FTE)/GP. Approximately 18% of practices employed administrative personnel, with the highest proportion in practices of employed GPs and the lowest in solo practices. Table 4 Personnel capacity of practices by organisational model Mean number of GPs (FTE)/practice Mean number of NPHCP (FTE) per GP Median number of NPHCP (FTE) per GP Single-GP–single-NPHCP practices (%) Practices with >1 NPHCP per GP (%) Practices with administrative staff (%) Mean number of administrative staff (FTE) per practice* Solo 1.0 1.1 1.0 75.9 17.7 14.2 0.8 Group 2.3 1.3 1.0 59.0 40.0 20.0 1.0 Network-based 3.5 0.9 0.8 75.0 8.3 33.3 1.8 Employed GPs 3.3 2.6 1.9 28.6 28.6 57.1 2.3 Abbreviation : NPHCP = non-physician healthcare personnel * Values refer only to practices employing administrative staff. Practices without such personnel were not included in the calculation. The delineation of responsibilities for non-physician personnel was predominantly informal. Competencies were most defined verbally (39.9%) or specified in employment contracts or their appendices (27.8%), whereas 9.5% of respondents reported that staff roles were not defined at all. Expert commentaries confirmed the predominance of solo practices and highlighted concerns regarding their sustainability, particularly in rural areas. Limited institutional support for team-based models was also noted. Generational patterns in organisational models of practice Organisational models varied by physician age. The proportion of solo practices was significantly higher among physicians aged 51–60 years and those aged 61 years and older, in whom solo practice represented the dominant organisational arrangement. In contrast, younger physicians demonstrated a more diverse organisational distribution, characterised by a greater prevalence of group practices and network-based models of care. The proportion of physicians working within group and network-based organisational models declined progressively with increasing age. The employment model within hospital settings remained marginal across all age groups (see Table 5). Table 5 Organisational models by physician age group Age group (years) Solo Group Network-based Employed GPs 25–30 37.5% 37.5% 25.0% 0% 31–40 39.3% 39.2% 14.3% 7.1% 41–50 61.5% 34.6% 1.9% 1.9% 51–60 76.0% 23.0% 0% 1.0% ≥61 83.3% 16.6% 0% 0% Note : Percentages are calculated within age groups. Expert commentaries highlighted work–life balance as a key determinant for younger physicians. Younger physicians were described as preferring team-based models that allow shared responsibilities, more predictable working hours, and a stronger focus on clinical work. Experts also noted that younger physicians were aware of the administrative burden associated with establishing and managing independent practices. Practice capacity and task distribution Non-physician healthcare personnel were primarily involved in basic clinical and administrative tasks, including specimen collection, administration of injections and vaccinations, and anthropometric measurements. Their involvement in patient education and care was reported by 46.1% of respondents. The transfer of prescribing and documentation-related responsibilities to non-physician staff remained relatively uncommon, reported by fewer than 20% of practices. Approximately 80% of practices did not employ administrative staff, and administrative tasks were typically handled by GPs or non-physician healthcare personnel. Where administrative personnel were present, they performed mainly organisational and financial tasks, patient communication, and documentation processing, with less frequent involvement in clinical activities. Across practices, physicians performed the majority of both clinical and administrative tasks (see Table 6). Table 6 Distribution of selected tasks by staff category GP Non-physician healthcare personnel Administrative staff Not performed Clinical procedures 34.1% 57.3% 0.4% 8.3% Administrative/organisational tasks 43.2% 49.4% 3.9% 3.4% Patient education and care 51.3% 46.1% 0.2% 2.5% Prescribing/documentation tasks 80.6% 18.6% 0.7% 0.1% Experts highlighted the administrative workload as a structural constraint. Financing, rather than physicians’ reluctance, was described as the main barrier to expanding non-physician roles. Access to care, referral patterns, and diagnostic capacity Indicators of patient load, time allocation, care organisation, and diagnostic resources varied across practice types. The mean number of registered patients per FTE GP was 1,726 (median 1,700), ranging from 1,874 in solo practices to 1,028 among employed GPs. The mean number of consultation hours per FTE GP was 27 hours per week (median 30 hours). The greatest time burden was reported by physicians in network-based practices (37 hours weekly), whereas employed GPs and those working in solo practices devoted an average of 27 hours per week to direct patient care. Administrative tasks accounted for a mean of 10.3 hours per week, with slightly higher values in solo and group practices. With respect to care organisation, 68.2% of respondents reported using designated time slots for different types of visits, whereas 29.9% did not employ such scheduling structures. Designated appointment slots were most common in group practices (71.9%), followed by solo (67.5%) and network-based practices (66.7%), whereas the proportion was substantially lower among employed GPs (28.6%). While 96.6% of practices reported providing acute care within 24 hours, only 18% were able to offer timely non-acute appointments. Waiting times exceeding 48 hours for non-urgent visits were most frequently reported among employed GPs (71.4%) and network-based practices (58.3%) (see Table 7). The role of the GP as the formal first point of contact is not legislatively established in the Czech context. Nevertheless, 80% of respondents indicated that specialist services required a referral from a GP in more than half of cases. In terms of diagnostic capacity, practices were typically equipped with basic instruments, such as point-of-care testing (POCT) analysers, electrocardiography, otoscopy, and pulse oximetry. More advanced diagnostic modalities were available in a minority of practices. Ultrasound examinations were available on-site in 74 practices, while an additional 25 provided these services on a limited basis. Five respondents reported fully independent provision of ultrasound diagnostics. Although 96% of respondents reported access to radiography within seven days, prolonged waiting times for imaging results, extending to several weeks, were reported sporadically in some regions. The mean waiting time for non-acute computed tomography (CT) was 34.7 days and for magnetic resonance imaging (MRI) 54.3 days (see Supplementary Figure S2). Table 7 Practice workload and access indicators by organisational model Solo Group Network-based Employed GPs Registered patients per GP (FTE), mean 1874 1410 1682 1028 Registered patients per GP (FTE), median 1800 1300 1300 931 Consultation hours per GP (FTE) per week, mean 27 33 37 27 Administrative hours per GP (FTE) per week, mean 10.6 10.3 5.6 9.0 Practices with designated visit-specific time slots (%) 67.5 71.9 66.7 28.6 Practices providing acute care within 24 h (%) 97.8 94.3 91.7 100 Practices with waiting time >48 h for non-urgent visits (%) 51.9 55.3 58.3 71.4 Expert commentaries highlighted regional variability in the availability of diagnostic equipment and examinations. Differences in reported waiting times for imaging services, particularly radiography, were attributed to heterogeneous regional conditions. Gatekeeping was described as functioning de facto, without formal legislative regulation of patients’ access to specialist care. Discussion This study demonstrates that organisational models of general practice shape the internal capacity of PC and its ability to coordinate care. Differences in staffing, delegation, and coordination reflect a historically embedded organisational settlement dominated by small, professionally autonomous practices. In line with previous research on the limits of system steerability in settings characterised by strong professional autonomy and small practice size [8,9], this configuration results in a fragmented organisational landscape with limited opportunities for systematic task delegation, team-based care, and stable coordination arrangements. This organisational configuration has direct implications for workforce capacity and task distribution within practices. The concentration of clinical, organisational, and administrative responsibilities within a single professional role limits the systematic involvement of non-physician health professionals and administrative staff, increasing workload pressures on GPs [21]. As observed in other PC systems dominated by small autonomous practices, limited task delegation appears less a matter of individual preference than a rational response to organisational environments lacking infrastructure for expanded team-based models [9,12]. Expert commentaries further suggested that these constraints are particularly pronounced in rural settings, where limited opportunities for collaboration and substitution intensify pressures on workforce capacity, consistent with evidence from rural PC systems elsewhere [22]. Taken together, organisational fragmentation emerges as a structural mechanism constraining both internal capacity and the ability of PC to fulfil its coordinating role within the healthcare system. Rather than indicating a clear advantage of any single organisational model, these findings align with evidence highlighting persistent trade-offs: small autonomous practices combine local adaptability with structurally limited internal capacity and heightened vulnerability to workforce shortages, particularly in rural contexts [23,24]. The analysis does not imply normative preference for larger or more integrated models, but rather demonstrates how different organisational arrangements distribute structural capacities and constraints in distinct ways. Beyond organisational fragmentation, limited internal capacity emerges as a closely related mechanism shaping PC functioning. In this context, internal capacity refers not to physician numbers but to the organisational ability to allocate tasks, delegate responsibilities, and integrate non-physician staff into everyday care processes. Positioned at the organisational level, internal capacity mediates between system-level expectations for coordination and the practical realities of everyday care delivery. This interpretation aligns with comparative evidence demonstrating the central role of team composition and organisational arrangements in structuring PC work [12]. In systems dominated by small, autonomous practices, such capacity remains structurally constrained. Limited delegation should therefore be understood not as resistance to change, but as a rational response to organisational environments lacking administrative support, stable team arrangements, and clearly institutionalised roles for non-physician personnel [25]. Cross-national evidence further shows that delegation is associated primarily with practice size, team composition, and organisational infrastructure rather than individual attitudes [26]. Attempts to expand delegation in the absence of such infrastructure may increase coordination costs and workload rather than reduce them, as supervisory and accountability responsibilities remain concentrated at the physician level [27]. This interpretation is further supported by mixed-methods research indicating that cumulative administrative workload and organisational change contribute to decisions to leave general practice or reduce clinical commitment [28]. From this perspective, internal capacity can be understood as an organisational property rather than an individual capability, dependent on stable team structures, administrative support, and embedded non-physician roles that enable sustainable delegation in everyday practice. A similar structural pattern has been observed in nurse-led PC models operating in fragmented healthcare systems [13]. Expert commentaries identified administrative workload as a central feature of GP practices and linked it directly to the scope for task delegation. One expert described a “competency cascade”, whereby responsibilities are transferred from specialists to GPs and subsequently to non-physician staff. The expansion of non-physician roles was consistently associated with available financial resources rather than with physicians’ willingness to delegate. Experts further emphasised the limited presence of administrative and newly defined support roles within existing organisational arrangements. As a result, highly qualified physicians frequently perform tasks that could be transferred to other professional groups. The absence of roles commonly established in other health systems was interpreted as reflecting institutional rigidity that may limit adaptation to increasing patient complexity. A pronounced generational dimension emerges in interaction with the organisational constraints identified above. Younger physicians are more frequently oriented towards collaborative, group-based, or employment-based arrangements, whereas older physicians remain predominantly in solo practice models. This pattern is consistent with international evidence documenting changing career preferences among younger GPs, including stronger preferences for group-based practices, salaried or hybrid employment arrangements, and reduced administrative burden [22,29–31]. These generational differences point to a growing institutional mismatch between the historically dominant model of independent practice ownership and contemporary career trajectories. The shift among younger physicians should not be interpreted as declining professional commitment, but as a rational response to organisational models that concentrate clinical, administrative, and entrepreneurial responsibilities within a single role. Generational change thus exposes the limited adaptability of arrangements anchored in individual ownership models and raises questions about the long-term sustainability of PC systems that fail to align organisational capacity with workforce expectations [32]. With respect to care coordination, our findings point to structural limitations in PC’s ability to fulfil its coordinating role within the healthcare system. GPs are widely involved in coordinating patient pathways, yet this role is not consistently supported by clearly defined authority, adequate access to diagnostic resources, or protected time for coordination activities. Comparative research shows that the institutionalisation of gatekeeping varies substantially across health system types and is less consistently formalised in insurance-based systems, where coordination responsibilities are often distributed across multiple actors rather than clearly anchored in PC [33,34]. In such contexts, gatekeeping tends to operate through partial, voluntary, or incentive-based arrangements rather than as a clearly institutionalised mechanism, resulting in heterogeneous and often informal coordination practices [35]. Rather than reflecting shortcomings of professional performance, these coordination gaps should be understood as the outcome of organisational arrangements that assign integrative responsibilities to PC without providing the institutional resources necessary to perform them effectively. At the same time, OECD PaRIS data indicate that patients in Czechia report comparatively high satisfaction with care coordination in international comparison [18]. This contrast suggests that patient-perceived coordination may reflect relational continuity and professional commitment rather than systematically institutionalised coordination mechanisms, and therefore does not contradict the structural constraints identified in this study. Taken together, these coordination problems represent cumulative outcomes of organisational fragmentation, limited internal capacity, and constrained task delegation across organisational models of general practice. At the system level, the findings reveal a policy paradox in the organisation of PC [36]. Although integrated care, interdisciplinary collaboration, and strengthened coordination are widely articulated as policy objectives [3,4], these expectations are layered onto organisational arrangements with limited capacity to absorb additional coordinating responsibilities. As a result, organisational fragmentation continues to shape how care is delivered in practice, with implications for equity, continuity, and the predictability of patient pathways. This study demonstrates that limitations in delegation, workforce use, and coordination are structurally embedded rather than driven by individual professional behaviour. Internal capacity and coordination emerge as organisational properties unevenly distributed across practice models and shape what PC is structurally able to deliver. Expert commentaries also reflected a more cautious assessment, suggesting that without targeted interventions in organisational and institutional structures, improvements in accessibility, effectiveness, and equity may remain limited. Several limitations should be considered when interpreting these findings. The analysis relies on self-reported data and may therefore be subject to reporting bias. The sample included a somewhat lower proportion of physicians aged 60 years and older compared with national workforce data, which may affect the interpretation of age-related patterns. The distribution of respondents across organisational models was uneven, resulting in smaller quantitative representation of some practice types. The study focuses on a single national context, limiting direct generalisability to other health systems. In addition, the study design does not permit causal inference regarding relationships between organisational models and care outcomes. However, the aim of the study is analytical rather than causal, and these limitations do not detract from the relevance of the structural mechanisms identified. Conclusion This study demonstrates that organisational models of general practice play a central role in shaping the internal capacity of PC and its ability to coordinate care. Drawing on evidence from the CR, it shows that variation in workforce capacity, task delegation, and coordination is structurally embedded in prevailing organisational arrangements rather than driven by individual professional choices. Conceptualising internal capacity as an organisational property highlights how limitations in delegation and coordination emerge as rational responses to fragmented practice structures and limited institutional support. These findings suggest that efforts to strengthen care coordination and integration may remain limited unless the organisational foundations of general practice are addressed. Although focused on a single national context, the mechanisms identified are relevant to other health systems facing similar organisational constraints. Abbreviations CR Czech Republic GP General Practitioner PC Primary Care Declarations Ethics approval The study protocol was reviewed and approved by the Ethics Committee of the Faculty of Biomedical Engineering, Czech Technical University in Prague (Approval No. C63/2025). The study was conducted in accordance with the Declaration of Helsinki. Consent to participate Participants were informed about the purpose of the study and participation was voluntary and anonymous. Completion of the questionnaire was considered as provision of informed consent. Consent for publication Not applicable. Availability of data and materials The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research received no external funding. Authors' contributions KH: Investigation; Formal analysis; Data curation; Visualization; Writing – review & editing. MC: Investigation; Writing – review & editing. ZK: Conceptualization; Methodology; Investigation; Writing – original draft; Writing – review & editing; Supervision. All authors contributed to the interpretation of the results and approved the final manuscript. Acknowledgements The authors would like to thank all general practitioners who participated in the survey for their time and valuable insights. We are also grateful to the invited experts for their thoughtful reflections and contributions, which helped to contextualise and interpret the findings. Footnotes Not applicable. References Primary health care on the road to universal health coverage: 2019 monitoring report [Internet]. World Health Organization; [cited 2026 Feb 15]. https://www.who.int/publications/i/item/9789240029040. Accessed 15 Feb 2026 Starfield B, Shi L, Macinko J. 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Health Policy. 2026;165:105529. https://doi.org/10.1016/j.healthpol.2025.105529 Czechia: Country Health Profile 2025. State of Health in the EU [Internet]. European Observatory on Health Systems and Policies. 2025 [cited 2026 Feb 5]. https://eurohealthobservatory.who.int/publications/m/czechia-country-health-profile-2025. Accessed 5 Feb 2026 Holcik J, Koupilova I. Primary health care in the Czech Republic: brief history and current issues. Int J Integr Care. 2000;1:e06. https://doi.org/10.5334/ijic.8 Ministry of Health of the Czech Republic. Strategic Framework for the Development of Health Care in the Czech Republic until 2030 [Internet]. 2020. https://zdravi2030.mzcr.cz/zdravi-2030-strategicky-ramec.pdf Ministry of Health of the Czech Republic. Strategic Analyses of the Needs of the Health Sector: A Concept Based on Available Data [Internet]. National Health Information Portal (NZIP). https://www.nzip.cz/koncepce2025 OECD. Does Healthcare Deliver?: Results from the Patient-Reported Indicator Surveys (PaRIS) [Internet]. OECD Publishing; 2025 [cited 2026 Feb 10]. https://doi.org/10.1787/c8af05a5-en National Register of Health Services Providers [Internet]. Institute of Health Information and Statistics of the Czech Republic. [cited 2026 Feb 15]. https://nrpzs.uzis.cz/. Accessed 15 Feb 2026 Personnel situation and education in primary care [Internet]. Ministry of Health of the Czech Republic. [cited 2026 Feb 15]. https://mzd.gov.cz/tiskove-centrum-mz/ministerstvo-zdravotnictvi-predstavilo-aktualni-data-z-primarni-pece-a-kroky-na-podporu-jeji-dostupnosti/. Accessed 15 Feb 2026 Jefferson L, Golder S, Castro-Avila A, Webster E, Anderson H, Dale V. General practice workforce retention strategies: an umbrella review. 2025; https://doi.org/10.1101/2025.01.21.25320715 Brown JB, Thorpe C, Bal S, George C, Jan SH, Mathews M, et al. Burden of administrative responsibilities in primary care. Can Fam Physician. 2025;71:e148–53. https://doi.org/10.46747/cfp.7106e148 Groenewegen P, Bosmans M, Boerma W. Rural and urban general practice: a comparison in 34 countries. Eur J Public Health. 2019;29:ckz185.409. https://doi.org/10.1093/eurpub/ckz185.409 Humphreys JS, Wakerman J, Wells R, Kuipers P, Jones JA, Entwistle P. “Beyond workforce”: a systemic solution for health service provision in small rural and remote communities. Medical Journal of Australia. 2008;188:S77–80. https://doi.org/10.5694/j.1326-5377.2008.tb01751.x Riisgaard H, Nexøe J. Successful task delegation in general practice – a way to maintain primary health care in the future. Scandinavian Journal of Primary Health Care. Taylor & Francis; 2017;35:111–2. https://doi.org/10.1080/02813432.2017.1335056 Groenewegen P, Boerma WGW, Spreeuwenberg P, Seifert B, Schäfer W, Batenburg R, et al. Task shifting from general practitioners to practice assistants and nurses in primary care: a cross-sectional survey in 34 countries. Primary Health Care Research & Development. 2022;23:e60. https://doi.org/10.1017/S1463423622000470 Edwards ST, Helfrich CD, Grembowski D, Hulen E, Clinton WL, Wood GB, et al. Task Delegation and Burnout Trade-offs Among Primary Care Providers and Nurses in Veterans Affairs Patient Aligned Care Teams (VA PACTs). J Am Board Fam Med. American Board of Family Medicine; 2018;31:83–93. https://doi.org/10.3122/jabfm.2018.01.170083 Doran N, Fox F, Rodham K, Taylor G, Harris M. Lost to the NHS: a mixed methods study of why GPs leave practice early in England. Br J Gen Pract. British Journal of General Practice; 2016;66:e128–35. https://doi.org/10.3399/bjgp16X683425 Pedersen LB, Kjær T, Kragstrup J, Gyrd-Hansen D. General practitioners’ preferences for the organisation of primary care: A discrete choice experiment. Health Policy. 2012;106:246–56. https://doi.org/10.1016/j.healthpol.2012.03.006 Pedersen LB, Gyrd-Hansen D. Preference for practice: a Danish study on young doctors’ choice of general practice using a discrete choice experiment. Eur J Health Econ. 2014;15:611–21. https://doi.org/10.1007/s10198-013-0500-5 Dale J, Potter R, Owen K, Parsons N, Realpe A, Leach J. Retaining the general practitioner workforce in England: what matters to GPs? A cross-sectional study. BMC Fam Pract. 2015;16:140. https://doi.org/10.1186/s12875-015-0363-1 Humphries N, Hanlon HR, O’Callaghan M, Byrne J-P, Cullen L, Murphy AW, et al. Changing Working Patterns in Irish general practice: Findings from a Qualitative Remote Ethnographic Study. Health Policy. 2026;164:105505. https://doi.org/10.1016/j.healthpol.2025.105505 Gérvas J, Ferna MP, Starfield BH. Primary Care, Financing and Gatekeeping in Western Europe. Fam Pract. 1994;11:307–17. https://doi.org/10.1093/fampra/11.3.307 Delnoij D, Van Merode G, Paulus A, Groenewegen P. Does General Practitioner Gatekeeping Curb Health Care Expenditure? J Health Serv Res Policy. SAGE Publications; 2000;5:22–6. https://doi.org/10.1177/135581960000500107 Rotar AM, Berg MJVD, Schäfer W, Kringos DS, Klazinga NS. Shared decision making between patient and GP about referrals from primary care: Does gatekeeping make a difference? PLOS ONE. Public Library of Science; 2018;13:e0198729. https://doi.org/10.1371/journal.pone.0198729 Ouimet M-J, Pineault R, Prud’homme A, Provost S, Fournier M, Levesque J-F. The impact of primary healthcare reform on equity of utilization of services in the province of Quebec: a 2003–2010 follow-up. Int J Equity Health. 2015;14:139. https://doi.org/10.1186/s12939-015-0243-2 Additional Declarations No competing interests reported. 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Strengthening PC has therefore become a key strategy for health system reform, reflecting its potential to improve population health while enhancing system efficiency and equity [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAcross Europe, PC systems are facing increasing pressure due to population ageing, the growing burden of chronic and multi-morbid conditions, rising patient expectations, workforce shortages, and the effects of recent crises, including the COVID-19 pandemic [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. These cumulative pressures have intensified efforts to identify how PC should be organised to function effectively under conditions of growing demand and complexity [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn many high-income countries, PC is predominantly delivered through small, professionally autonomous practices, which has important implications for how care is organised and coordinated and can complicate attempts to translate system-level ambitions into routine practice [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAt the same time, PC is not organisationally uniform. Across countries, general practice is delivered through a wide range of organisational models that differ in practice size, team composition, and degree of integration, from solo practices to larger, multidisciplinary and collaborative settings [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Emerging evidence shows that these organisational arrangements are not a neutral backdrop, but actively shape care coordination, workforce dynamics and service delivery, with collaborative and multidisciplinary models associated with more favourable outcomes in some contexts [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRather than focusing on specific team-based interventions or predefined care models, this study addresses the organisational conditions that shape what general practice is structurally able to deliver in everyday PC. In this context, internal capacity is conceptualised as an organisational property of general practice, referring to the structural ability of practices to allocate and redistribute tasks, integrate non-physician staff, and sustain coordination functions within existing institutional arrangements [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e Yet, despite growing expectations and increasing policy emphasis on integrated and coordinated PC, empirical evidence on how organisational models of general practice shape internal capacity\u0026mdash;particularly with regard to care coordination\u0026mdash;remains limited. Therefore, the aim of this study is to analyse how organisational models of general practice shape the internal capacity of PC and its capacity for care coordination. The analysis focuses on empirically observable differences between organisational models with regard to organisational structure, workforce capacity and task delegation, generational patterns among GPs, and the organisation and coordination of care.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe analysis presented in this study focuses on the PC system in the CR, characterised by a persistent dominance of small, professionally autonomous general practices alongside growing policy expectations in this sector. PC is delivered by GPs for adults and by GPs for children and adolescents. This study focuses exclusively on GPs providing care to adult patients, who typically operate as self-employed providers contracted within the publicly funded health insurance system. While patient registration with a specific GP is not legally mandatory, access to routine PC is organised through a patient registration system [14].\u003c/p\u003e\n\u003cp\u003eThe current organisational configuration of Czech PC is shaped by a strong path-dependent development linked to the post-socialist transformation of the healthcare system. Prior to 1989, healthcare provision was highly centralised and organised through territorially defined public institutions. The healthcare reforms of the 1990s led to rapid decentralisation and the dissolution of integrated district-based structures, alongside the expansion of independently operating ambulatory providers and a strengthened role of outpatient specialist care [15]. These reforms were accompanied by regulatory arrangements, including restrictions on prescribing and referral practices for GPs, which contributed to a fragmented organisation of care and limited formal integration between levels of the healthcare system. Key structural features established during this transition have persisted into the present system, despite more recent policy efforts aimed at redefining and strengthening the role of GPs within Czech healthcare [16].\u003c/p\u003e\n\u003cp\u003eNational workforce data indicate pronounced demographic ageing among GPs, with a growing share of physicians aged 60 years and older, raising concerns about the sustainability and internal capacity of PC provision [17].\u003c/p\u003e\n\u003cp\u003eAt the same time, international comparative evidence from the OECD Patient-Reported Indicator Surveys (PaRIS) indicates that Czech PC performs relatively strongly on patient-reported measures of continuity and perceived care coordination, while levels of trust in the healthcare system remain below the average of participating EU countries [18]. These system characteristics form the contextual background for the empirical analysis.\u003c/p\u003e\n\u003ch4\u003eStudy design\u003c/h4\u003e\n\u003cp\u003eThis study employed a mixed-methods design, combining a cross-sectional quantitative survey with a subsequent qualitative component in the form of expert commentaries to contextualise and interpret the survey findings.\u003c/p\u003e\n\u003ch4\u003eSurvey and sampling\u003c/h4\u003e\n\u003cp\u003eThe quantitative component consisted of an online survey targeting GPs for adults. GPs listed in the National Register of Healthcare Providers of the Institute of Health Information and Statistics of the CR were invited to participate [19]. A total of 356 respondents completed the questionnaire (see Additional File 1), representing approximately 6.6% of all GPs in the Czech Republic. At a 5% significance level, the sampling error was below 5.1% for a 50% proportion and 3.0% for a 10% proportion. Participation was voluntary and anonymous. Data collection took place between January and March 2024.\u003c/p\u003e\n\u003cp\u003eThe questionnaire included closed-ended (single- and multiple-choice) and open-ended items, primarily requesting numerical responses. It covered organisational models, personnel composition, staff competencies, practice infrastructure, number of registered patients, care organisation, and waiting times for acute and non-acute consultations. For analysis, organisational models were grouped into four categories reflecting differences in organisational structure and employment arrangements: solo, group, network-based, and employed practices. This harmonised classification was used to enhance analytical clarity and international comparability (see Supplementary Figure S1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSolo practices included single-physician practices, regardless of whether they operated independently or within a polyclinic. Group practices comprised two or more GPs, including both formally integrated teams and practices sharing premises without full organisational integration. Network-based practices operated as part of a provider network or chain with shared ownership or management. Employed GPs worked under an employment contract within hospital outpatient departments.\u003c/p\u003e\n\u003ch4\u003eExpert commentaries\u003c/h4\u003e\n\u003cp\u003eFollowing the preliminary analysis of the survey data, a qualitative interpretative component was conducted in the form of expert commentaries. The aim of this component was \u003cstrong\u003enot to generate new empirical categories\u003c/strong\u003e, but to capture expert perspectives on the observed patterns and to support interpretation of the quantitative results. All experts received the same structured comment template summarising key survey findings (see Additional File 2). The purpose was to obtain contextual, structural, and policy-oriented reflections on the identified patterns rather than to reassess the statistical analysis. Experts were selected based on their professional expertise and standing in PC, including representatives of professional associations of GPs and nurses, as well as representatives of the Ministry of Health. \u003cstrong\u003eSeven experts\u0026nbsp;\u003c/strong\u003e(four women and three men)\u003cstrong\u003e\u0026nbsp;were invited, of whom five provided written responses.\u003c/strong\u003e Expert input was used to contextualise the quantitative findings and to inform interpretation of structural and workforce-related implications. All participating experts consented to having their professional roles disclosed. An overview of expert characteristics is provided in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e List of experts\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eExpert\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eExpert name\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eExpert position\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eKateřina Javorsk\u0026aacute;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGeneral Practitioner; Member of the SVL ČLS JEP Committee\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBohumil Seifert\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVice President and Scientific Secretary, the SVL ČLS JEP committee\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDana Jur\u0026aacute;skov\u0026aacute;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFormer Minister of Health of the Czech Republic\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLudmila Bezd\u0026iacute;čkov\u0026aacute;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMember of the Committee of the Association of General Practitioners of the Czech Republic and the SVL ČLS JEP;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHead of the Department of General Practice, IPVZ\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eJan Př\u0026aacute;da\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVice President of the Czech Medical Chamber\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 614px;\"\u003e\n \u003cp\u003e\u003cem\u003eAbbreviations\u003c/em\u003e: \u003cem\u003eSVL ČLS JEP\u003c/em\u003e = Society of General Practice, Czech Medical Society of Jan Evangelista Purkyně; \u003cem\u003eIPVZ\u003c/em\u003e = Institute for Postgraduate Medical Education.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch4\u003eData analysis\u003c/h4\u003e\n\u003cp\u003eSurvey data were exported from Google Forms and analysed using descriptive and comparative statistical methods. Results were stratified by organisational model, age of the GP, and region.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eExpert commentaries were analysed using a qualitative interpretative approach. All written responses were read in full and subjected to thematic categorisation focusing on how experts explained, contextualised, or problematised the quantitative findings. Particular attention was paid to areas of convergence and divergence across expert perspectives. The analysis aimed to identify underlying structural explanations rather than to generate new empirical categories. Interpretations were discussed among the authors prior to integration with the survey results. Findings from both components were integrated at the interpretation stage.\u003c/p\u003e\n\u003cp\u003eThe study protocol was reviewed and approved by the Ethics Committee of the Faculty of Biomedical Engineering, Czech Technical University in Prague (Approval No. C63/2025) (see Additional File 3).\u003cbr\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003ch4\u003eRespondent characteristics\u003c/h4\u003e\n\u003cp\u003eThe survey included 356 GPs for adults. The sample was predominantly female (66.6%). The age distribution was concentrated among middle-aged and older physicians, with a median age of 51 years. The youngest age group (25\u0026ndash;30 years) comprised 2.2% of respondents. Participants were recruited from all regions of the CR, with the highest proportions in Prague and the South Moravian Region (see Table 2). The gender distribution closely reflects national workforce data reported by the Ministry of Health [20].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e Respondent characteristics\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 254px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 254px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eWomen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e237\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 254px;\"\u003e\n \u003cp\u003e66.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eMen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 254px;\"\u003e\n \u003cp\u003e33.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 254px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 254px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e51.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 254px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e25\u0026ndash;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 254px;\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e31\u0026ndash;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 254px;\"\u003e\n \u003cp\u003e18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e41\u0026ndash;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 254px;\"\u003e\n \u003cp\u003e28.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e51\u0026ndash;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 254px;\"\u003e\n \u003cp\u003e28.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u0026ge;61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 254px;\"\u003e\n \u003cp\u003e22.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 254px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eCapital City of Prague\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 254px;\"\u003e\n \u003cp\u003e14.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eSouth Moravian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 254px;\"\u003e\n \u003cp\u003e12.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eCentral Bohemian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 254px;\"\u003e\n \u003cp\u003e11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eMoravian-Silesian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 254px;\"\u003e\n \u003cp\u003e7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u0026Uacute;st\u0026iacute; nad Labem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 254px;\"\u003e\n \u003cp\u003e7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eSouth Bohemian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 254px;\"\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eVysočina\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 254px;\"\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eOlomouc\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 254px;\"\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003ePlzeň\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 254px;\"\u003e\n \u003cp\u003e5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eHradec Kr\u0026aacute;lov\u0026eacute;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 254px;\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eLiberec\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 254px;\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eZl\u0026iacute;n\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 254px;\"\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003ePardubice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 254px;\"\u003e\n \u003cp\u003e3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eKarlovy Vary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 254px;\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe following sections present findings on organisational models, workforce capacity, task delegation, and care coordination, integrating quantitative results with expert commentary.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ch4\u003eOrganisational fragmentation and professional autonomy as structural characteristics of the system\u003c/h4\u003e\n\u003cp\u003eThe distribution of organisational models indicates a predominance of solo practices within Czech PC (Table 3). Solo practices represented the predominant model, accounting for approximately 65% of respondents. Of these, 29% were administratively affiliated with a polyclinic or another healthcare facility, while continuing to operate as independent offices.\u0026nbsp;Group and team-based practices accounted for 29.5% of respondents.\u0026nbsp;3.4% reported employment in network-based practices, and 2% practised as employed GPs.\u003c/p\u003e\n\u003cp\u003eMultidisciplinary organisational arrangements were uncommon in Czech PC. The involvement of physicians from other specialties within the same workplace was reported by 9% of respondents, primarily within traditional polyclinic settings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e Distribution of respondents by organisational model\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSolo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNetwork-based\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployed GPs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e65.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e29.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eOrganisational models differed substantially in terms of practice size and staffing capacity. Variation in practice scale and internal workforce resources by organisational model is summarised in Table 4. The mean number of full-time equivalent (FTE) GPs per site was highest in network-based practices (3.5 FTEs) and lowest in solo practices (1.0 FTE).\u003c/p\u003e\n\u003cp\u003eThese differences were also reflected in the staffing structure of practices.\u0026nbsp;Overall, the availability of non-physician healthcare personnel was low. The mean ratio of non-physician healthcare personnel to GP FTEs was 1.16.\u0026nbsp;Nearly 70% of practices followed a one-physician\u0026ndash;one-non-physician staffing model (most frequently in solo practices and least frequently among employed GPs). Fewer than 25% of practices employed more than 1 non-physician healthcare personnel (FTE)/GP.\u003c/p\u003e\n\u003cp\u003eApproximately 18% of practices employed administrative personnel, with the highest proportion in practices of employed GPs and the lowest in solo practices.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u003c/strong\u003e Personnel capacity of practices by organisational model\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean number of GPs (FTE)/practice\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean number of NPHCP (FTE) per GP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian number of NPHCP (FTE) per GP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSingle-GP\u0026ndash;single-NPHCP practices\u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePractices with \u0026gt;1 NPHCP per GP (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePractices with administrative staff (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean number of administrative staff (FTE) per practice*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSolo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e75.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e17.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e14.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e59.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e40.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e20.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNetwork-based\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e75.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployed GPs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e28.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e28.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e57.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eAbbreviation\u003c/em\u003e: NPHCP = non-physician healthcare personnel\u003c/p\u003e\n\u003cp\u003e* Values refer only to practices employing administrative staff. Practices without such personnel were not included in the calculation.\u003c/p\u003e\n\u003cp\u003eThe delineation of responsibilities for non-physician personnel was predominantly informal. Competencies were most defined verbally (39.9%) or specified in employment contracts or their appendices (27.8%), whereas 9.5% of respondents reported that staff roles were not defined at all.\u003c/p\u003e\n\u003cp\u003eExpert commentaries confirmed the predominance of solo practices and highlighted concerns regarding their sustainability, particularly in rural areas. Limited institutional support for team-based models was also noted.\u003c/p\u003e\n\u003ch4\u003eGenerational patterns in organisational models of practice\u003c/h4\u003e\n\u003cp\u003eOrganisational models varied by physician age. The proportion of solo practices was significantly higher among physicians aged 51\u0026ndash;60 years and those aged 61 years and older, in whom solo practice represented the dominant organisational arrangement. In contrast, younger physicians demonstrated a more diverse organisational distribution, characterised by a greater prevalence of group practices and network-based models of care. The proportion of physicians working within group and network-based organisational models declined progressively with increasing age. The employment model within hospital settings remained marginal across all age groups (see Table 5).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5\u003c/strong\u003e Organisational models by physician age group\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"605\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge group (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSolo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNetwork-based\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployed GPs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e25\u0026ndash;30\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e37.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e37.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e25.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e31\u0026ndash;40\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e39.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e39.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e14.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e7.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e41\u0026ndash;50\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e61.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e34.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e1.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e1.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e51\u0026ndash;60\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e76.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e23.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e1.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge;61\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e16.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote\u003c/em\u003e: Percentages are calculated within age groups.\u003c/p\u003e\n\u003cp\u003eExpert commentaries highlighted work\u0026ndash;life balance as a key determinant for younger physicians. Younger physicians were described as preferring team-based models that allow shared responsibilities, more predictable working hours, and a stronger focus on clinical work. Experts also noted that younger physicians were aware of the administrative burden associated with establishing and managing independent practices.\u003c/p\u003e\n\u003ch4\u003ePractice capacity and task distribution\u003c/h4\u003e\n\u003cp\u003eNon-physician healthcare personnel were primarily involved in basic clinical and administrative tasks, including specimen collection, administration of injections and vaccinations, and anthropometric measurements. Their involvement in patient education and care was reported by 46.1% of respondents. The transfer of prescribing and documentation-related responsibilities to non-physician staff remained relatively uncommon, reported by fewer than 20% of practices.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eApproximately 80% of practices did not employ administrative staff, and administrative tasks were typically handled by GPs or non-physician healthcare personnel. Where administrative personnel were present, they performed mainly organisational and financial tasks, patient communication, and documentation processing, with less frequent involvement in clinical activities. Across practices, physicians performed the majority of both clinical and administrative tasks (see Table 6).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6\u003c/strong\u003e Distribution of selected tasks by staff category\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eGP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNon-physician healthcare personnel\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAdministrative staff\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNot performed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eClinical procedures\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e34.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e57.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAdministrative/organisational tasks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e43.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e49.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePatient education and care\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e51.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e46.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePrescribing/documentation tasks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e80.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eExperts highlighted the administrative workload as a structural constraint. Financing, rather than physicians\u0026rsquo; reluctance, was described as the main barrier to expanding non-physician roles.\u003c/p\u003e\n\u003ch4\u003eAccess to care, referral patterns, and diagnostic capacity\u003c/h4\u003e\n\u003cp\u003eIndicators of patient load, time allocation, care organisation, and diagnostic resources varied across practice types.\u0026nbsp;The mean number of registered patients per FTE GP was 1,726 (median 1,700), ranging from 1,874 in solo practices to 1,028 among employed GPs.\u0026nbsp;The mean number of consultation hours per FTE GP was 27 hours per week (median 30 hours).\u0026nbsp;The greatest time burden was reported by physicians in network-based practices (37 hours weekly), whereas employed GPs and those working in solo practices devoted an average of 27 hours per week to direct patient care.\u0026nbsp;Administrative tasks accounted for a mean of 10.3 hours per week, with slightly higher values in solo and group practices.\u003c/p\u003e\n\u003cp\u003eWith respect to care organisation, 68.2% of respondents reported using designated time slots for different types of visits, whereas 29.9% did not employ such scheduling structures. Designated appointment slots were most common in group practices (71.9%), followed by solo (67.5%) and network-based practices (66.7%), whereas the proportion was substantially lower among employed GPs (28.6%). While 96.6% of practices reported providing acute care within 24 hours, only 18% were able to offer timely non-acute appointments. Waiting times exceeding 48 hours for non-urgent visits were most frequently reported among employed GPs (71.4%) and network-based practices (58.3%) (see Table 7).\u003c/p\u003e\n\u003cp\u003eThe role of the GP as the formal first point of contact is not legislatively established in the Czech context.\u0026nbsp;Nevertheless, 80% of respondents indicated that specialist services required a referral from a GP in more than half of cases.\u003c/p\u003e\n\u003cp\u003eIn terms of diagnostic capacity, practices were typically equipped with basic instruments, such as point-of-care testing (POCT) analysers, electrocardiography, otoscopy, and pulse oximetry. More advanced diagnostic modalities were available in a minority of practices. Ultrasound examinations were available on-site in 74 practices, while an additional 25 provided these services on a limited basis. Five respondents reported fully independent provision of ultrasound diagnostics. Although 96% of respondents reported access to radiography within seven days, prolonged waiting times for imaging results, extending to several weeks, were reported sporadically in some regions. The mean waiting time for non-acute computed tomography (CT) was 34.7 days and for magnetic resonance imaging (MRI) 54.3 days (see Supplementary Figure S2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7\u003c/strong\u003e Practice workload and access indicators by organisational model\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSolo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNetwork-based\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eEmployed GPs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eRegistered patients per GP (FTE), mean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1874\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1410\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1682\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1028\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eRegistered patients per GP (FTE), median\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1800\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e931\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eConsultation hours per GP (FTE) per week, mean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAdministrative hours per GP (FTE) per week, mean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePractices with designated visit-specific time slots (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e67.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e71.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e66.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePractices providing acute care within 24 h (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e97.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e94.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePractices with waiting time \u0026gt;48 h for non-urgent visits (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e51.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e55.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e58.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e71.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eExpert commentaries highlighted regional variability in the availability of diagnostic equipment and examinations. Differences in reported waiting times for imaging services, particularly radiography, were attributed to heterogeneous regional conditions. Gatekeeping was described as functioning de facto, without formal legislative regulation of patients\u0026rsquo; access to specialist care.\u003cs\u003e\u003cbr\u003e\u0026nbsp;\u003c/s\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study demonstrates that organisational models of general practice shape the internal capacity of PC and its ability to coordinate care. Differences in staffing, delegation, and coordination reflect a historically embedded organisational settlement dominated by small, professionally autonomous practices. In line with previous research on the limits of system steerability in settings characterised by strong professional autonomy and small practice size [8,9], this configuration results in a fragmented organisational landscape with limited opportunities for systematic task delegation, team-based care, and stable coordination arrangements.\u003c/p\u003e\n\u003cp\u003eThis organisational configuration has direct implications for workforce capacity and task distribution within practices. The concentration of clinical, organisational, and administrative responsibilities within a single professional role limits the systematic involvement of non-physician health professionals and administrative staff, increasing workload pressures on GPs [21]. As observed in other PC systems dominated by small autonomous practices, limited task delegation appears less a matter of individual preference than a rational response to organisational environments lacking infrastructure for expanded team-based models [9,12]. Expert commentaries further suggested that these constraints are particularly pronounced in rural settings, where limited opportunities for collaboration and substitution intensify pressures on workforce capacity, consistent with evidence from rural PC systems elsewhere [22].\u003c/p\u003e\n\u003cp\u003eTaken together, organisational fragmentation emerges as a structural mechanism constraining both internal capacity and the ability of PC to fulfil its coordinating role within the healthcare system. Rather than indicating a clear advantage of any single organisational model, these findings align with evidence highlighting persistent trade-offs: small autonomous practices combine local adaptability with structurally limited internal capacity and heightened vulnerability to workforce shortages, particularly in rural contexts [23,24]. The analysis does not imply normative preference for larger or more integrated models, but rather demonstrates how different organisational arrangements distribute structural capacities and constraints in distinct ways.\u003c/p\u003e\n\u003cp\u003eBeyond organisational fragmentation, limited internal capacity emerges as a closely related mechanism shaping PC functioning. In this context, internal capacity refers not to physician numbers but to the organisational ability to allocate tasks, delegate responsibilities, and integrate non-physician staff into everyday care processes. \u003cstrong\u003ePositioned at the organisational level, internal capacity mediates between system-level expectations for coordination and the practical realities of everyday care delivery.\u003c/strong\u003e This interpretation aligns with comparative evidence demonstrating the central role of team composition and organisational arrangements in structuring PC work [12]. In systems dominated by small, autonomous practices, such capacity remains structurally constrained.\u003c/p\u003e\n\u003cp\u003eLimited delegation should therefore be understood not as resistance to change, but as a rational response to organisational environments lacking administrative support, stable team arrangements, and clearly institutionalised roles for non-physician personnel [25]. Cross-national evidence further shows that delegation is associated primarily with practice size, team composition, and organisational infrastructure rather than individual attitudes [26]. Attempts to expand delegation in the absence of such infrastructure may increase coordination costs and workload rather than reduce them, as supervisory and accountability responsibilities remain concentrated at the physician level [27]. This interpretation is further supported by mixed-methods research indicating that cumulative administrative workload and organisational change contribute to decisions to leave general practice or reduce clinical commitment [28].\u003c/p\u003e\n\u003cp\u003eFrom this perspective, internal capacity can be understood as an organisational property rather than an individual capability, dependent on stable team structures, administrative support, and embedded non-physician roles that enable sustainable delegation in everyday practice. A similar structural pattern has been observed in nurse-led PC models operating in fragmented healthcare systems [13].\u003c/p\u003e\n\u003cp\u003eExpert commentaries identified administrative workload as a central feature of GP practices and linked it directly to the scope for task delegation. One expert described a \u0026ldquo;competency cascade\u0026rdquo;, whereby responsibilities are transferred from specialists to GPs and subsequently to non-physician staff. The expansion of non-physician roles was consistently associated with available financial resources rather than with physicians\u0026rsquo; willingness to delegate. Experts further emphasised the limited presence of administrative and newly defined support roles within existing organisational arrangements. As a result, highly qualified physicians frequently perform tasks that could be transferred to other professional groups. The absence of roles commonly established in other health systems was interpreted as reflecting institutional rigidity that may limit adaptation to increasing patient complexity.\u003c/p\u003e\n\u003cp\u003eA pronounced generational dimension emerges in interaction with the organisational constraints identified above. Younger physicians are more frequently oriented towards collaborative, group-based, or employment-based arrangements, whereas older physicians remain predominantly in solo practice models. This pattern is consistent with international evidence documenting changing career preferences among younger GPs, including stronger preferences for group-based practices, salaried or hybrid employment arrangements, and reduced administrative burden\u0026nbsp;[22,29\u0026ndash;31].\u003c/p\u003e\n\u003cp\u003eThese generational differences point to a growing institutional mismatch between the historically dominant model of independent practice ownership and contemporary career trajectories. The shift among younger physicians should not be interpreted as declining professional commitment, but as a rational response to organisational models that concentrate clinical, administrative, and entrepreneurial responsibilities within a single role. Generational change thus exposes the limited adaptability of arrangements anchored in individual ownership models and raises questions about the long-term sustainability of PC systems that fail to align organisational capacity with workforce expectations [32].\u003c/p\u003e\n\u003cp\u003eWith respect to care coordination, our findings point to structural limitations in PC\u0026rsquo;s ability to fulfil its coordinating role within the healthcare system. GPs are widely involved in coordinating patient pathways, yet this role is not consistently supported by clearly defined authority, adequate access to diagnostic resources, or protected time for coordination activities.\u003c/p\u003e\n\u003cp\u003eComparative research shows that the institutionalisation of gatekeeping varies substantially across health system types and is less consistently formalised in insurance-based systems, where coordination responsibilities are often distributed across multiple actors rather than clearly anchored in PC [33,34]. In such contexts, gatekeeping tends to operate through partial, voluntary, or incentive-based arrangements rather than as a clearly institutionalised mechanism, resulting in heterogeneous and often informal coordination practices [35].\u003c/p\u003e\n\u003cp\u003eRather than reflecting shortcomings of professional performance, these coordination gaps should be understood as the outcome of organisational arrangements that assign integrative responsibilities to PC without providing the institutional resources necessary to perform them effectively.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eAt the same time, OECD PaRIS data indicate that patients in Czechia report comparatively high satisfaction with care coordination in international comparison [18]. This contrast suggests that patient-perceived coordination may reflect relational continuity and professional commitment rather than systematically institutionalised coordination mechanisms, and therefore does not contradict the structural constraints identified in this study.\u003c/p\u003e\n\u003cp\u003eTaken together, these coordination problems represent cumulative outcomes of organisational fragmentation, limited internal capacity, and constrained task delegation across organisational models of general practice. At the system level, the findings reveal a policy paradox in the organisation of PC [36]. Although integrated care, interdisciplinary collaboration, and strengthened coordination are widely articulated as policy objectives [3,4], these expectations are layered onto organisational arrangements with limited capacity to absorb additional coordinating responsibilities. As a result, organisational fragmentation continues to shape how care is delivered in practice, with implications for equity, continuity, and the predictability of patient pathways.\u003c/p\u003e\n\u003cp\u003eThis study demonstrates that limitations in delegation, workforce use, and coordination are structurally embedded rather than driven by individual professional behaviour. Internal capacity and coordination emerge as organisational properties unevenly distributed across practice models and shape what PC is structurally able to deliver.\u003c/p\u003e\n\u003cp\u003eExpert commentaries also reflected a more cautious assessment, suggesting that without targeted interventions in organisational and institutional structures, improvements in accessibility, effectiveness, and equity may remain limited.\u003c/p\u003e\n\u003cp\u003eSeveral limitations should be considered when interpreting these findings. The analysis relies on self-reported data and may therefore be subject to reporting bias. The sample included a\u0026nbsp;somewhat lower proportion of physicians aged 60 years and older compared with national workforce data, which may affect the interpretation of age-related patterns. The distribution of respondents across organisational models was uneven, resulting in smaller quantitative representation of some practice types. The study focuses on a single national context, limiting direct generalisability to other health systems. In addition, the study design does not permit causal inference regarding relationships between organisational models and care outcomes. However, the aim of the study is analytical rather than causal, and these limitations do not detract from the relevance of the structural mechanisms identified.\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates that organisational models of general practice play a central role in shaping the internal capacity of PC and its ability to coordinate care. Drawing on evidence from the CR, it shows that variation in workforce capacity, task delegation, and coordination is structurally embedded in prevailing organisational arrangements rather than driven by individual professional choices.\u003c/p\u003e\n\u003cp\u003eConceptualising internal capacity as an organisational property highlights how limitations in delegation and coordination emerge as rational responses to fragmented practice structures and limited institutional support. These findings suggest that efforts to strengthen care coordination and integration may remain limited unless the organisational foundations of general practice are addressed. Although focused on a single national context, the mechanisms identified are relevant to other health systems facing similar organisational constraints.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCR Czech Republic\u003c/p\u003e\n\u003cp\u003eGP General Practitioner\u003c/p\u003e\n\u003cp\u003ePC Primary Care\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval\u003c/p\u003e\n\u003cp\u003eThe study protocol was reviewed and approved by the Ethics Committee of the Faculty of Biomedical Engineering, Czech Technical University in Prague (Approval No. C63/2025). The study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003eConsent to participate\u003c/p\u003e\n\u003cp\u003eParticipants were informed about the purpose of the study and participation was voluntary and anonymous. Completion of the questionnaire was considered as provision of informed consent.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003eKH: Investigation; Formal analysis; Data curation; Visualization; Writing \u0026ndash; review \u0026amp; editing. MC: Investigation; Writing \u0026ndash; review \u0026amp; editing. ZK: Conceptualization; Methodology; Investigation; Writing \u0026ndash; original draft; Writing \u0026ndash; review \u0026amp; editing; Supervision. All authors contributed to the interpretation of the results and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all general practitioners who participated in the survey for their time and valuable insights. We are also grateful to the invited experts for their thoughtful reflections and contributions, which helped to contextualise and interpret the findings.\u003c/p\u003e\n\u003cp\u003eFootnotes\u003c/p\u003e\n\u003cp\u003eNot applicable. \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePrimary health care on the road to universal health coverage: 2019 monitoring report [Internet]. World Health Organization; [cited 2026 Feb 15]. https://www.who.int/publications/i/item/9789240029040. 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Health Policy. 2026;164:105505. https://doi.org/10.1016/j.healthpol.2025.105505\u003c/li\u003e\n\u003cli\u003eG\u0026eacute;rvas J, Ferna MP, Starfield BH. Primary Care, Financing and Gatekeeping in Western Europe. Fam Pract. 1994;11:307\u0026ndash;17. https://doi.org/10.1093/fampra/11.3.307\u003c/li\u003e\n\u003cli\u003eDelnoij D, Van Merode G, Paulus A, Groenewegen P. Does General Practitioner Gatekeeping Curb Health Care Expenditure? J Health Serv Res Policy. SAGE Publications; 2000;5:22\u0026ndash;6. https://doi.org/10.1177/135581960000500107\u003c/li\u003e\n\u003cli\u003eRotar AM, Berg MJVD, Sch\u0026auml;fer W, Kringos DS, Klazinga NS. Shared decision making between patient and GP about referrals from primary care: Does gatekeeping make a difference? PLOS ONE. Public Library of Science; 2018;13:e0198729. https://doi.org/10.1371/journal.pone.0198729\u003c/li\u003e\n\u003cli\u003eOuimet M-J, Pineault R, Prud\u0026rsquo;homme A, Provost S, Fournier M, Levesque J-F. The impact of primary healthcare reform on equity of utilization of services in the province of Quebec: a 2003\u0026ndash;2010 follow-up. Int J Equity Health. 2015;14:139. https://doi.org/10.1186/s12939-015-0243-2\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Primary care, General practice, Organisational models, Care coordination, Internal capacity, Task delegation, Workforce organisation, Czech Republic","lastPublishedDoi":"10.21203/rs.3.rs-8898745/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8898745/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePrimary 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eAn explanatory sequential mixed-methods design was applied. A cross-sectional online survey of general practitioners (GPs) providing care to adult patients (n\u0026thinsp;=\u0026thinsp;356) examined organisational models, workforce capacity, task delegation, and care coordination. Descriptive and comparative statistical methods were used. Structured expert commentaries were used to contextualise and interpret quantitative findings.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOrganisational models were systematically associated with differences in workforce capacity, task delegation, and care coordination. The predominance of small, professionally autonomous practices was associated with limited involvement of non-physician staff, constrained delegation, and high administrative workloads. Expert commentaries 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.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eOrganisational models fundamentally shape the internal capacity of PC and its ability to coordinate care. Limitations in delegation and coordination are structurally embedded in prevailing organisational arrangements rather than driven by individual professional choices.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"Organisational models of general practice and internal capacity for care coordination: a mixed-methods study from the Czech Republic","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-02 14:42:05","doi":"10.21203/rs.3.rs-8898745/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-07T08:48:49+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-03T20:56:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"203918265307145247582522138026153817797","date":"2026-03-13T06:17:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"3008637877465599833307069864773002264","date":"2026-03-12T22:30:44+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-06T15:03:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"294515675497265276737347097710951811653","date":"2026-02-23T14:40:36+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-23T13:51:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-20T01:33:53+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-20T01:33:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Primary Care","date":"2026-02-17T07:50:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2a5c002f-bae0-4d0d-a0ea-c8f7acfef563","owner":[],"postedDate":"March 2nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-15T14:09:14+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-02 14:42:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8898745","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8898745","identity":"rs-8898745","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}