Family doctor contract services are essential for universal health coverage and are widely implemented internationally, playing a key role in China’s primary healthcare system. With rising chronic disease burdens and stronger policy support, systematically assessing enrollment and its determinants is vital to improving service quality and effectiveness.This study aims to evaluate the national family doctor contract rate and identify its main influencing factors, providing a scientific basis for optimizing contract services.We systematically searched cross-sectional studies on family doctor contract rates in China published between January 2018 and December 2023 in both Chinese and English databases. Two researchers independently conducted literature screening, data extraction, and quality assessment using the JBI tool. Stata 17.0 was used to perform meta-analysis, employing a random-effects model to pool contract rates and integrate effect sizes for influencing factors.A total of 18 studies were included. The pooled national family doctor contract rate was 54.37% (95% CI: 41.81%–66.66%), with a significant urban-rural disparity: urban areas had a higher contract rate (63.6%) than rural areas (40.8%). Key factors influencing enrollment included older age (OR = 1.029, 95% CI: 1.012–1.047), unemployment (OR = 1.517, 95% CI: 1.046–2.223), presence of chronic disease (OR = 1.709, 95% CI: 1.636–1.786), poorer economic status (OR = 3.177, 95% CI: 2.552–3.955), possession of medical insurance (OR = 1.994, 95% CI: 1.687–2.354), and awareness of contract services (OR = 8.174, 95% CI: 7.106–9.412).Contract uptake remains moderate and well below the 2035 target, with pronounced urban–rural inequity suggesting uneven service capacity and access. Cross-sectional heterogeneity limits causal interpretation. Policies should strengthen rural staffing and resources, raise public awareness and trust, and embed chronic-disease prevention and follow-up. Longitudinal, implementation-focused evaluations are needed.While notable progress has been made in family doctor contract services in China, a gap remains toward the 2035 target of 75% coverage, particularly in rural areas. The ongoing "Strengthening Primary Care" strategy, through optimized resource allocation, enhanced workforce incentives, and service model innovation, holds promise for improving the accessibility and sustainability of contract services, thereby supporting the gradual achievement of high-quality universal coverage.

The main principle in the development of the healthcare system is ensuring access to medical services for the population, particularly at the level of primary health care (PHC). One of the key factors contributing to the achievement of this criterion is the availability of an adequate number of healthcare professionals to serve the population.The main principle in the development of the healthcare system is ensuring access to medical services for the population, particularly at the level of primary health care (PHC). One of the key factors contributing to the achievement of this criterion is the availability of an adequate number of healthcare professionals to serve the population.The objective of this study is to examine the trends in the availability of family physicians in the Kyrgyz Republic over the period from 1996 to 2024.A retrospective analysis of primary data was conducted, including official reports on human resources from the Center for eHealth of the Ministry of Health of the Kyrgyz Republic for the period 2000–2024; collections of regulatory and methodological documents related to the activities of family physician groups and Family Medicine Centers; and data from the literature published in publicly available sources. Data were statistically processed using Microsoft Excel.The availability of family physicians has increased since 2000, reaching 1,867 in 2024; however, a substantial shortage remains, with a deficit of 2,416, highlighting the need for effective workforce planning and retention measures, particularly in remote areas.Although the number of family physicians in the Kyrgyz Republic has increased since 2000, the workforce remains inadequate to meet the needs of the population, highlighting ongoing challenges in planning primary health care personnel. The shortage is influenced by population growth, uneven geographic distribution, migration, and limited retention, especially in rural and remote regions.Despite substantial growth in the number of family physicians over the past two decades, a significant workforce shortage persists in the Kyrgyz Republic. The 2024 deficit highlights the need for sustainable workforce planning and effective retention strategies, particularly in remote and underserved areas, to ensure access to high-quality primary health care.

An increasing number of municipalities in Norway have introduced work-leave rotation (sometimes called "fly in, fly out" rotation) for general practitioners, whereby the doctors alternate between fixed periods of work and leave. A study published in 2024 (1) found that these communties were overwhelmingly rural and that they chose to introduce rotating positions du to chronic recruitment difficulties (resulting in a high turnover of physicians) or high out-of-hours work burden for local general practitioners (GPs). It also showed that this type of novel work arrangement was successful in recruiting GPs to these municipalities. However, as many of the GPs had been recently hired, the study could not determine if work-leave rotation was successful in retaining doctors. Nor were patients´ experiences with rotating doctors examined. We have not found previous studies (apart from the reference included) on this topic.The objectives of the current sudy is two-fold. Firstly, it aims to follow up the results of the original publication from 2024 (1) by investigating if those original municipalities were in fact able to retain GPs and if this affects turnover rates. Secondly, it will investigate how patients experience having a rotating doctor as their GP.We will conduct an exploratory multiple-case study using quantitative as well as qualitative data from different municipalities that have introduced work-leave rotation for GPs. The case-study methodology is flexible and permits a practice-oriented and holistic approach that includes multiple perspectives, with a variety of data sources that help provide insight. Starting January 2026 we will undertake interviews with physicians and patients as well as sourcing government health data. The study has received fundring from The Norwegian centre for Rural Medicine.Data collection starts January 2026. Preliminary results will be presented at the conference.NA at this point.NA at this point.   References 1. Prestgaard EE, Fosse A, Abelsen B, Harbitz MB. Work-leave rotation among general practitioners in Norwegian municipalities. Tidsskr Nor Laegeforen. 2024 Nov 19;144(14). English, Norwegian. doi: 10.4045/tidsskr.24.0089. PMID: 39605150.

In 2022 NHS Forth Valley GPs had difficulty attracting doctors to work in the more deprived areas The LMC requested a "deep dive" report into the issues affecting recruitment & retention of GPs This highlighted the need for: - earlier engagement of medical students (we have no local medical school) & junior doctors (outreach lectures) - setting up a very successful First5 WhatsApp group/meet & connect "support bubble" - inviting GP trainees along too to encourage networking & social cohesion - sending out an Exit Survey to every Dr who left a post over a 2-year period This work has helped under-doctored deprived areas get more workforce, thus helping to reduce the health inequity of the Inverse Care lawResearch of the literature 28 x informal interviews 35 x Exit Surveys Ongoing work & feedbackExit Surveys - highlight the "ABC" needs of GP - Autonomy, Belonging & Competence/mastery (also Complexity/variety) First5 Drs have stayed locally more & gone for Partnership sooner Our work is being recognised nationallyThis was first presented at NHS Education Scotland with very positive feedback - Scottish Government also requested our data Many learning points have been learnt & will be passed on in this report presentationMaking a few simple changes can massively improve recruitment & retention in under-doctored areas

Spain is developing a new Action Plan for Primary Health Care (PHC) that places strong emphasis on retention of talent, including a specific mandate to incentivise the return of professionals who have left PHC and to address ongoing patterns of attrition and displacement.The overall aim is to analyse the factors driving professional displacement from PHC—both within Spain and internationally—and to generate actionable recommendations to improve retention and facilitate return. The specific objectives are: (1) to identify the main determinants influencing departures from PHC; and (2) to develop tailored recommendations to promote the return and long-term retention of Family Doctors (FDs) and Community Nurses (CNs) at national and regional levels.The study focuses on FDs and CNs and adopts a multi-method design grounded in an international conceptual framework on retention and return, adapted to the Spanish context. The framework structure is: (A) employment and remuneration; (B) working conditions and organisation; (C) professional development and career; and (D) meso-level management and autonomy. Four components will be conducted between October 2025 and February 2026: (1) Documentary review (2022–2025): Analysis of Spanish and international literature, including grey literature and policy documents. (2) Quantitative analysis: Descriptive and comparative assessment of the availability, distribution and contracting of FD and CN nurses across regions (2022–2025), using official statistical and administrative sources. (3) Normative and organisational mapping: Examination of regulations, incentives, contracting models and governance arrangements across regions. (4) Qualitative inquiry: Exploration of experiences, challenges and proposed improvements through 20–30 semi-structured interviews and 2–3 focus groups with family doctors, community nurses, professional associations, unions and health system managers. Data will be analysed thematically.Findings from all components will be integrated by dimension and professional category. Using a problem–measure–responsible–timeframe matrix and a multi-criteria prioritisation approach (impact, feasibility, cost, equity and acceptability).This project generate evidence-informed, context-sensitive recommendations to strengthen retention and foster the return of FDs and CNs, ultimately contributing to the sustainability and quality of PHCThe project will produce a clear synthesis of the determinants of attrition and mobility in PHC

In France, access to primary care has reached an unprecedented crisis point. Thousands of patients no longer have a primary care physician and therefore lose access to essential healthcare. New organizational models are urgently needed.nstead of asking a lot from a few physicians, this initiative sought to ask a little from many. The model consisted of implementing a weekly rotation involving several hundred general practitioners within health centers established in underserved rural areas. Through this continuous relay system, a permanent medical presence was restored in eleven villages previously deprived of care. Rather than relying on a single family doctor, patients now benefit from a “family of doctors.” As of 1 November 2025, 900 general practitioners are engaged in the program. Three main profiles have emerged: retired physicians (35%), locum doctors (30%), and established physicians (25%), whether in private practice or employed positions. Retired physicians provide more than 60% of weekly rotations. Since the beginning of the initiative, more than 70,000 medical consultations have been carried out, and over 12,000 patients are followed regularly; the centers can register them as their primary care provider.The experience highlights physicians’ willingness to contribute to underserved areas, particularly among retired doctors. Short, flexible commitments appear attractive across profiles. Success depends on centralized logistics ensuring reliable coordination and coherent continuity for patients. Caution is required regarding clinical coordination, shared tools, and longitudinal follow-up. This model suggests that resource-sharing innovations could be extended to other underserved regions, provided quality and acceptability are formally evaluated.This initiative shows that large-scale mobilization of physicians can restore access to care. Key challenges include long-term quality, practice variability, and operational sustainability.This proof of concept demonstrates that innovative organizational approaches can restore continuous primary care in chronically underserved territories.