PurposeThe purpose of this paper is to reflect on research evidence and practice experience of transforming primary care to a more integrated and holistic model.Design/methodology/approachIt is based on a scoping review which has been guided by primary care stakeholders and synthesises research evidence and practice experience from ten international case studies.FindingsAdopting an inter-professional, community-orientated and population-based primary care model requires a fundamental transformation of thinking about professional roles, relationships and responsibilities. Team-based approaches can replicate existing power dynamics unless medical clinicians are willing to embrace less authoritarian leadership styles. Engagement of patients and communities is often limited due to a lack of capacity and belief that will make an impact. Internal (relationships, cultures, experience of improvement) and external (incentives, policy intentions, community pressure) contexts can encourage or derail transformation efforts.Practical implicationsTransformation requires a co-ordinated programme that incorporates the following elements – external facilitation of change; developing clinical and non-clinical leaders; learning through training and reflection; engaging community and professional stakeholders; transitional funding; and formative and summative evaluation.Originality/valueThis paper combines research evidence and international practice experience to guide future programmes to transform primary care.

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Cultural competence is a phenomenon that straddles many disciplines and fields of study. There is no settled definition of the term, and it is argued that this is not necessary to explore or discuss the phenomenon as it is context-dependent across diverse societies. Explorations of cultural competence in clinical education and training are well-established, but there has been less attention towards its expression in the field of developing healthcare leaders. There is a debate about whether cultural competence is best achieved primarily through training-based educational inputs or by being infused in all areas of curriculum development. Using an exploration of selected literature followed by the case of an ambitious set of leadership development programmes in the English National Health Service, this paper explores the balance and interdependencies of cultural competence in healthcare leadership development as knowledge, skills and attitudes. The paper concludes that it is important for educators in this field to provide space for reflection, develop skills of reflexivity and facilitate sensitive discussions of sometimes contested ideas and concepts. A further evaluation of the impact of teaching and learning interventions, while mapping developments in perceptions of knowledge, skill and attitudes would be an area ripe for future research.

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