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In the USA, primary care is usually defined as comprehensive or coordinated care that is delivered by physicians practicing general internal medicine, family practice, or pediatrics. Obstetrics and gynecology is sometimes included under the auspices of primary care since many women, particularly during the childbearing years, rely on these physicians for preventive services. Over the last 50 years, the funding models for primary care in the USA have been inconsistent and fragmented, resulting in a complex and inadequate funding system. Although many countries have developed government‐sponsored, universal health care plans, the USA did not choose this route. Rather, significant change in US medicine has been the intended or unintended result of legislation and market‐forces.

Policy reforms to primary health care delivery in New Zealand required government-funded firms overseeing care delivery to be constituted as nonprofit entities with governance shared between consumers and producers. This paper examines the consumer and producer interests in these firmsʼ allocation of ownership and control utilising theories of competition. Consistent with pre-reform patterns of ownership and control, provider interests appear to have exerted effective control over these entitiesʼ formation and governance in all but a few cases where community (consumer) control pre-existed. Their ability to do so is implied from the absence of a defined ownership stake and the changes to incentives facing the different stakeholding groups. It appears that the pre-existing patterns will prevail and further intervention will be required if policy-makers are to achieve their underlying aims.

As Australia struggles to meet increased demand for healthcare and contain expenditure there has been a focus on primary care and its role in demand management and keeping people out of expensive secondary care. However, with domestic policy struggling to find a suitable approach consideration of English policy could well be fruitful in the quest to strengthen and develop primary care in Australia. The purpose of this paper is to consider policy developments in England and explores these in relation to the Australian healthcare system.

The authors highlight the key changes to policy that have occurred in the English healthcare system in recent years, and discuss whether they have proven successful. The authors discuss the barriers to implementing similar approaches in Australia, particularly the difference in system structure that would necessitate policy adaptation.

Whilst there are differences in the structure and organisation of funding and service provision between countries, there are developments in England that are worthy of consideration from an Australian perspective. These include a focus on funding and commissioning that rewards quality not just activity and volume. As Australia sees the development of new primary care organisations that are tasked with commissioning then developments and lessons around the technical and relational aspects will be important to consider.

The work highlights that Australia might consider learning from the English experience in this area and the types of incentives that may increase efficiency and quality of health service provision. This is important as it potentially gives greater certainty about those approaches most likely to yield beneficial outcomes for patients and the broader system.

The Models of Child Health Appraised (MOCHA) project identified the different models of primary care that exist for children, examined the particular attributes that might be different from those directed at adults and considered how these models might be appraised. The project took the multiple and interrelated dimensions of primary care and simplified them into a conceptual framework for appraisal. A general description of the models in existence in all 30 countries of the EU and EEA countries, focusing on lead practitioner, financial and regulatory and service provision classifications, was created. We then used the WHO ‘building blocks’ for high-performing health systems as a starting point for identifying a good system for children. The building blocks encompass safe and good quality services from an educated and empowered workforce, providing good data systems, access to all necessary medical products, prevention and treatments, and a service that is adequately financed and well led. An extensive search of the literature failed to identify a suitable appraisal framework for MOCHA, because none of the frameworks focused on child primary care in its own right. This led the research team to devise an alternative conceptualisation, at the heart of which is the core theme of child centricity and ecology, and the need to focus on delivery to the child through the life course. The MOCHA model also focuses on the primary care team and the societal and environmental context of the primary care system.

This paper seeks to analyse accountability relationships developed since the introduction of reforms requiring nonprofit primary health organisations (PHOs) to discharge holistic accountability.

Case study data were obtained principally through semi‐structured interviews with PHOs and their key stakeholders, observation of formal and informal meetings, and primary and secondary documents.

While government strategy requires these PHOs to discharge holistic accountability, prior hierarchical‐based practices linger. A major impediment to securing holistic accountability is the failure of the new strategy to define clearly how the funder and provider should share accountability for improving their community's health. The implementation of holistic accountability was retarded when funders' propensity to control outcomes coincided with providers' lack of enthusiasm for embracing a greater range of stakeholders. The history and structure of individual PHOs was a key indicator of whether they discharged hierarchical or holistic accountability.

This case study research is context‐specific and may have limited applicability to other PHOs or jurisdictions. However, the study shows that when funders and providers build trust rather than depending on control, holistic accountability relationships can be developed.

Despite government intention that primary health care relationships will lead to holistic accountability, this will not occur until funders clearly define responsibilities and trust their service providers.

There is a paucity of research into government‐sponsored holistic accountability relationships with local nonprofit service providers. This research provides a unique contextual analysis of the perspectives of funders, providers and a wide group of stakeholders and the operationalisation of two different styles of accountability.

The purpose of this paper is to review the establishment of Primary Health Network (PHN) in Australia and its utility in commissioning Primary Health Care (PHC) services.

This study is an analysis of management practice about the establishment and development of a PHN as a case study over the three-year period. The PHN is the Hunter New England and Central Coast PHN (HNECCPHN). The study is based on “insiders perspectives” drawing from documentation, reports and evaluations undertaken.

HNECCPHN demonstrates a unique inclusive organisation across a substantial diverse geographic area. It has taken an innovative and evidence-based approach to its creation, governance and operation. HNECCPHN addresses the health challenges of a substantial Aboriginal and/or Torres Strait Islander population. It contains significant and diverse urban, coastal and distinct rural, regional and remote populations. It can be described as a “virtual” organisation, using a distributed network of practice approach to engage clinicians, communities and providers. The authors describe progress and learning in the context of theories of complex organisations, innovation, networks of practice, knowledge translation and social innovation.

The study provides initial publication into the establishment phase of a PHN in Australia.

The study describes the implementation and progress in terms of relevant international practice and theoretical concepts. This paper demonstrates significant innovative practice in the short term.

The study describes significant engagement and the importance of that with and between communities, service providers and health professionals.

This is the first study of the results of the implementation of an important change in the funding and delivery of PHC in Australia.

The purpose of this paper is to report on the origins, development and early impacts of a Health Care Home (HCH) model of care being rolled out around New Zealand (NZ).

This paper draws on a literature review on HCHs and related developments in primary health care, background discussions with key players, and a review of significant HCH implementation documents.

The HCH model of care is emerging from the sector itself and is being tailored to local needs and to meet the needs of local practices. A key focus in NZ seems to be on business efficiency and ensuring sustainability of general practice – with the assumption that freeing up general practitioner time for complex patients will mean better care for those populations. HCH models of care differ around the world and NZ needs its own evidence to show the model’s effectiveness in achieving its goals.

It is still early days for the HCH model of care in NZ and the findings in this paper are based on limited evidence. Further evidence is needed to identify the model’s full impact over the next few years.

This paper is one of the first to explore the HCH model of care in NZ.

Canada’s primary care system has been described as “a culture of pilot projects” with little evidence of converting successful initiatives into funded, permanent programs or sharing project outcomes and insights across jurisdictions. Health services pilot projects are advocated as an effective strategy for identifying promising models of care and building integrated care partnerships in local settings. In the qualitative study reported here, the purpose of this paper is to investigate the strengths and challenges of this approach.

Semi-structured interviews were conducted with 34 primary care physicians who discussed their experiences as pilot project leads. Following thematic analysis methods, broad system issues were captured as well as individual project information.

While participants often portrayed themselves as advocates for vulnerable patients, mobilizing healthcare organizations and providers to support new models of care was discussed as challenging. Competition between local healthcare providers and initiatives could impact pilot project success. Participants also reported tensions between their clinical, project management and research roles with additional time demands and skill requirements interfering with the work of implementing and evaluating service innovations.

Study findings highlight the complexity of pilot project implementation, which encompasses physician commitment to addressing care for vulnerable populations through to the need for additional skill set requirements and the impact of local project environments. The current pilot project approach could be strengthened by including more multidisciplinary collaboration and providing infrastructure supports to enhance the design, implementation and evaluation of health services improvement initiatives.

Purpose – The aim of this paper is to examine the effects of government reforms to improve the accountability of primary healthcare providers in Scotland. As a result of the reforms, funding arrangements for GP practices changed and new financing mechanisms were introduced; this paper seeks to investigate the impact of these changes. Design/methodology/approach – The investigation is undertaken using a case study method involving a medical practice in Dundee. Interviews were conducted with staff at the practice and one researcher spent a week on site studying documentation and observing procedures. Findings – The main findings from the case study suggest that as a result of the government reforms, new funding allocation procedures for the practice better resemble a system of financial control rather than demonstrating financial accountability. GPs were more willing to engage in discussions regarding new procedures being introduced to demonstrate clinical accountability; they did not anticipate that practice accreditation or professional revalidation would alter their established practices in any way. Research limitations/implications – The main limitation of this research is that it only relates to one case study in Dundee. In addition, further government reforms in this area mean that follow up case studies are needed to see how subsequent changes have addressed the issues raised in the current research; indeed, some longitudinal studies might investigate how cumulative reforms have impacted upon GPs. Orginality/value – Nevertheless, despite these limitations, this paper does build on previous work in this area and provides a platform on which subsequent work can build.