Across Europe, healthcare systems are facing a structural challenge that can no longer be solved by doing more of the same. Demand is rising, populations are ageing, more people are living with chronic disease, and clinical workforce shortages are becoming one of the defining constraints on health system performance.
Yet many healthcare systems are still organised around assumptions from another era: that the physical clinic is the default point of access, that every patient should ideally see the same doctor for every issue, and that digital care is an exception rather than part of core infrastructure.
The debate needs to move on from “digital versus physical” care. The more important question is whether each patient is being directed to the right level of care, at the right time, with the right clinical competence and the right degree of continuity.
A system designed for yesterday’s needs
Traditional primary care was built for a world in which populations were smaller, fewer conditions could be treated, and fewer people lived for decades with ongoing care needs. A patient could visit a local family doctor because the match between where clinicians worked and where patients lived was more realistic.
Today, that model is under pressure. Clinicians are not evenly distributed geographically. Rural and underserved communities struggle to recruit healthcare professionals, while urban centres face growing demand. At the same time, a larger share of healthcare activity is no longer about curing a single episode of illness, but about managing long-term conditions, repeated follow-ups and complex needs.
Trying to scale the old model indefinitely is neither economically nor operationally sustainable. Not every patient needs the same type of contact. Patients with chronic disease, multimorbidity or frailty often need continuity, multidisciplinary teams and proactive follow-up. Patients with bounded, low-complexity or episodic needs may instead need rapid access, guidance and resolution.
A modern health system must be able to distinguish between these needs.
From institutions to functional levels of care
Healthcare should increasingly be organised around functional levels of care, rather than historical institutions. A practical model includes at least seven levels:
- Specialist and emergency hospital care for acute, complex and highly specialised interventions.
- Full-service physical primary care with diagnostic capacity, multidisciplinary teams and continuity for complex patients.
- Local light-touch primary care hubs offering examinations, tests, procedures and follow-up closer to patients.
- Digital primary care for planned consultations, follow-ups, medication reviews and advice that can safely be delivered remotely.
- Digital urgent care for rapid triage and management of low-acuity acute problems, especially outside office hours.
- Navigation and advisory services helping patients understand where to go next.
- AI-supported self-care and guidance, increasingly used by patients before contacting the formal healthcare system.
Most of these levels already exist in some form. The problem is that reimbursement, regulation and organisational structures often fail to recognise them as part of one coherent system.
When lower-intensity levels are unavailable, patients do not simply disappear. They move upward – often to more expensive and less appropriate settings. A patient who cannot access timely digital urgent care may attend an emergency department. A patient who cannot get guidance may seek repeated appointments. A patient who cannot navigate the system may face delays or unequal access.
Restricting the lowest levels of care does not reduce demand. It shifts demand elsewhere.
Digital care is not just video consultation
Digital care should not be understood as a video version of the traditional clinic visit. Used well, it changes how healthcare capacity is organised. It can support triage, structured follow-up, chronic disease check-ins, medication renewals, test-result reviews, mental health support and low-acuity urgent care.
This matters especially outside office hours. In many systems, patients with urgent but non-emergency needs face two options: wait until the next day or attend emergency care. A digital urgent care level can provide a safer and more efficient alternative, helping determine whether the patient needs self-care, a prescription, a planned primary care appointment or escalation.
But to deliver real value, digital care must be integrated into the wider system. It needs clear clinical governance, shared data, appropriate reimbursement and defined responsibilities. A digital front door that is disconnected from the rest of healthcare risks becoming another layer of fragmentation.
AI is already becoming part of the care pathway
Large language models and AI-based tools are already changing patient behaviour. People use them to understand symptoms, prepare for appointments, interpret medical terminology and explore self-care options. Whether health systems formally approve of this or not, it is already happening.
The policy challenge is therefore not whether AI should exist in healthcare. It does. The challenge is how to make its use safe, transparent, clinically governed and equitable.
Not all AI use carries the same risk. Administrative support, patient education, symptom navigation, clinical decision support and autonomous decision-making should not be treated as one category. Regulation should be proportionate, with clear distinctions between low-risk support functions and higher-risk clinical applications.
If the pathway for responsible AI adoption becomes too slow, uncertain or costly, innovation may move outside regulated healthcare environments. Patients will still use AI –
but without integration, governance or accountability.
Reimbursement must follow the patient pathway
New care levels cannot succeed if reimbursement remains tied to old categories. Payment models often reward physical visits, institutional boundaries and legacy workflows rather than resolution, access or appropriate routing.
Future reimbursement should be technology-neutral. It should define required capabilities – quality, safety, interoperability, data sharing and reporting – rather than force every provider into the same platform or process.
This is particularly important for hybrid models. A hub-and-spoke approach can allow full-service primary care centres to support smaller local units. Local hubs can provide examinations and tests close to patients, while larger clinical teams provide digital access, extended hours, specialist support and resilience. Such models are especially relevant in regions with long distances, sparse populations or recruitment challenges.
Continuity where it matters most
A common concern is that digital and distributed care may weaken continuity. Poorly designed systems can do that. But well-designed systems can achieve the opposite.
By routing simpler needs to appropriate lower-intensity levels, healthcare systems can protect continuity for the patients who need it most. Complex patients should not compete for the same appointment capacity as patients whose needs can be safely resolved through digital urgent care, structured advice or a local hub.
Access and continuity are not opposites. Better access at the right level can make meaningful continuity more achievable.
Healthcare does not lack technology. It often lacks the organisational courage to redesign around it. The next phase of reform should not be about defending the old model or promoting digital care for its own sake. It should be about building systems that use every level of care intelligently.
The goal is better care: more accessible, more equitable, more sustainable and more focused on the patients who need clinical continuity the most.
