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

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