The Case for Integrated Primary Care Across 10 Countries

Primary care touches almost every aspect of our health. Beyond delivering essential preventive services — such as annual physicals, screenings, and vaccinations — and managing chronic conditions, its scope has expanded to include treating mental health issues and assessing and understanding the broader conditions impacting patients’ well-being, such as access to safe housing, a stable income, and nutritious food.1 However, this expansion comes at a time when primary care physicians are already stretched thin.2

In the United States, administrative burdens, long work hours, and the high cost of medical school, coupled with lower pay relative to specialties, have discouraged medical graduates from entering primary care. These factors also have contributed to widespread burnout, leading some primary care physicians to reduce their clinical hours or leave practice altogether, exacerbating workforce shortages in recent years.3

Recognizing these pressures, many primary care providers are increasingly delegating certain responsibilities to other qualified professionals within their own practice, including nurses, physician assistants, physical therapists, social workers, and mental health providers. This team-based model expands the range of essential services available to patients, strengthens the comprehensiveness of care, and increases efficiency in practices overall.4

Using data from the 2025 Commonwealth Fund International Health Policy Survey, this brief examines the composition of care teams within primary care practices and how equipped practices say they are to meet their patient needs in preventive care, the management of chronic conditions, and mental health and social support. The brief covers 10 countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the United Kingdom, and the United States (for more information, see “How We Conducted This Survey”).

Key Findings

Having a diverse range of providers within a primary care practice can improve patient care as nurses, nurse practitioners, and physician assistants can assume portions of the clinic workload, reducing the risk of burnout for physicians.5 Additionally, integrating pharmacists, physical therapists, and nutritionists directly into the practice enables patients to access these services more easily, with all health records transferred efficiently and care coordinated under one roof.6

Across countries, there is considerable variation in provider composition within primary care practices.7 For example, nearly all primary care physicians in New Zealand, Sweden, and the United Kingdom report that their practice includes nurses, compared to only about one-third in the Netherlands. Conversely, nearly all Dutch primary care physicians say their practice employs physician assistants, whereas only about one in 10 primary care physicians in Australia, New Zealand, and Sweden say the same. While nearly all primary care physicians in the U.K. say their practice includes at least one pharmacist, less than 10 percent in Germany and Sweden say the same. Primary care physicians in the U.S. report levels of other providers in the middle of the range for most provider types.

Integrating behavioral health specialists such as mental health providers and social workers into primary care can expand access to treatment and reduce the stigma surrounding addiction and mental health issues.8 Social workers, in particular, can serve as trusted allies to patients and play an essential role in helping them connect with critical resources and navigate the wider impacts of health challenges.9 By addressing issues like food insecurity, housing instability, and unemployment, they can improve patients’ overall well-being, which can in turn improve health.

Despite these benefits, there is considerable variation in whether primary care practices employ mental health providers. Likewise, the inclusion of social workers in primary care practices varies significantly across countries, though fewer than half of primary care physicians in any country report that their practice employs social workers.

Employing a diverse range of provider types is important if practices hope to meet their patients’ needs. Our study finds a significant share of the conditions primary care physicians treat stem from mental health issues, unmet social needs, and inadequate preventive care, regardless of country. About half or more of primary care physicians in all countries — except Sweden, where the rate is around four in 10 — report that “a lot” of the conditions they manage are driven by mental health issues. Additionally, at least one of five physicians in every country except France reported that a substantial portion of the conditions they treat are due to social factors. The rate jumped to about half in New Zealand and the U.K.

Across countries, roughly 20 percent or more of physicians said that “a lot” of the conditions they treat stem from inadequate access to preventive care — despite every country except the U.S. having universal health systems that guarantee coverage of preventive services.10

Despite differences in the composition of providers within primary care practices, a majority of primary care physicians in all 10 countries report feeling their practice is well prepared to manage care for patients with chronic conditions. This suggests the makeup of provider types is mostly sufficient to address these needs.

However, there is wide variation in how prepared physicians feel to address mental health needs. Less than half of physicians in France and the U.S. felt well prepared, while three in four physicians in the Netherlands reported feeling well prepared. Among physicians in all countries who reported feeling ill prepared, the most cited reason was a lack of available services or specialists to refer their patients to (data not shown).

When it comes to addiction-related issues, few physicians across countries feel adequately prepared to provide treatment. Among physicians in all countries who reported feeling not prepared, the most cited reasons for this were a lack of knowledge or skills needed to treat these conditions and a lack of services or providers to refer the patient to (data not shown).

Discussion and Conclusion

Across countries, a substantial amount of unmet patient health needs within primary care practices stems from insufficient preventive care and unaddressed mental health and social needs. Yet there is wide variation in how prepared physicians feel to address these needs. If primary care providers do not feel adequately equipped to provide this type of support, their patients may be less likely to receive high-quality, comprehensive, and continuous care. Additionally, providers may be more prone to burnout when forced to provide care beyond their capacity.11

Expanding primary care teams can improve access and patient outcomes, and addresses workforce shortages. Extensive research shows that expanding primary care teams to include a broader mix of provider types can ease the pressure on physicians to manage all aspects of patient care. Expanding the role of highly trained nurse practitioners and physician assistants — who can provide care comparable to primary care physicians — can help address the growing shortage of primary care providers. Other countries have already moved in this direction. The Netherlands, for example, extended the autonomous scope of practice of nurse practitioners and physician assistants in 2018, while the United Kingdom gave nurses full prescribing authority in 2006.12

Likewise, integrated primary care can also expand access to mental health and social services, particularly for racial, ethnic, and geographic minorities, improving overall health outcomes.13 In Germany, for example, where about half of providers reported that “a lot” of their patients have mental health needs, almost no primary care phycicians report that their practice includes mental health providers on their staff. In New Zealand and the U.K., where about half of physicians reported that “a lot” of their patients’ health issues stem from social and economic conditions, only about one-quarter of primary care physicians report that their practice includes social workers.

Efforts are underway to advance team-based primary care in the U.S. The decades-long Patient-Centered Medical Home Recognition program, developed by the National Committee for Quality Assurance, encourages practices throughout the country to employ a team-based approach to care through enhanced communication, task delegation, and coordinated care transitions and referrals.14 The Collaborative Care Model, when adopted by primary care practices, allows patients to receive care from their primary care team, a behavioral health care manager, and a consulting psychiatrist.15 Psychiatrists can therefore see more patients than in a typical one-on-one setting, and patients show better short- and long-term mental health outcomes, and are less likely to go to the emergency room. Community health centers, which provide care for underserved patients and communities, have long embedded behavioral health specialists and other providers in primary care to meet the needs of their patient populations.16 In 2024, Medicare expanded the types of providers that can bill for behavioral health services and began covering peer support specialists and community health workers.17

Still, several barriers hinder the expansion and integration of primary care in the U.S.:

• Effective integration requires significant upfront costs to hire and train staff, implement shared health information systems that ensure strong communication and collaboration across the primary care team, and develop new quality improvement processes.18 This kind of infrastructure is generally not reimbursable and can have ongoing costs that may be difficult for practices to afford.19
• By reimbursing providers for individual services rather than the whole-care experience, the country’s traditional fee-for-service payment model discourages integrated, team-based care.20
• The growing underinvestment in primary care makes it difficult for practices to meet the comprehensive needs of their patients.21 Since 2019, investment in primary care has steadily declined across all health care payers.22
• Twenty-three states still require physician supervision for nurse practitioners, rather than granting them the autonomy to diagnose, treat, and prescribe for a defined set of conditions without physician oversight.23

In the United States, policymakers can support team-based care models by expanding and increasing payment for primary care to cover the full range of services delivered by interprofessional teams and increasing investment to attract more professionals to the field. Adopting value-based payment models, which pay providers based on the quality and outcomes of care they deliver, can also reward care integration. Finally, providing training for primary care professionals to strengthen team-based care and tracking progress over time are critical.24

The composition of primary care teams varies widely between countries, and no country is fully prepared to meet patients’ needs across the spectrum of care. We know that expecting already-stretched physicians to deliver the full range of primary care services is not conducive to high-quality patient care. Ensuring primary care practices comprise diverse provider types — including behavioral health specialists equipped to handle mental health and social issues — is essential for meeting patients’ needs and alleviating some of the burden on overstretched physicians.