关键词: 全科医生, 金牌家庭医生团队, 基层医疗卫生, 政策实施, ROCCIPI

Abstract: Background　Family doctor teams are key gatekeepers of residents' health; however, their development commonly faces bottlenecks such as formalistic contracting and mismatches between capacity and resources. Tianjin has designated the development of "Gold Medal Family Doctor Teams" as a 2025 people-centered initiative, yet gaps remain between policy implementation outcomes and the original design intent, warranting a systematic diagnosis. Objective　To systematically identify barriers to the development of Gold Medal Family Doctor Teams and propose optimization strategies. Methods　From May 2025 to October 2025, an interview guide was developed based on relevant literature and the study objectives. Using purposive sampling, data were collected through semi-structured interviews with 20 experts, and problems were identified using the ROCCIPI framework (Rules, Opportunity, Capacity, Communication, Interest, Process, Ideology) . Results　The issues were not isolated; rather, they stemmed from three sets of underlying contradictions. At the institutional level, the decoupling of administrative recommendation from incentives undermined the credibility and value of the "gold medal" designation. At the operational level, a fixed pairing support model and fragmented information systems failed to meet real-world service needs. At the organizational level, limited team autonomy and excessive workload among members hindered substantive service delivery. These intertwined contradictions constrained the intended benchmarking role of Gold Medal teams. Accordingly, four strategies are proposed：(1) establish a developmental incentive mechanism featuring “dynamic accreditation linked to honorary recognition”; (2) build a flexible support system integrating a “specialty resource pool” with an intelligent referral platform; (3) grant teams greater autonomy supplemented with process-oriented management tools; and (4) on the basis of policy standardization and public communication, explore pilot programs for paid service packages. Conclusion　Based on the key informant evidence, this study extracts three sets of transferable contradictory structures："Selection and Incentive", "Support and Synergy", and "Organization and Empowerment", and then constructs corresponding policy tool combinations, providing operational mechanism explanations and intervention paths for the benchmarking policy of grassroots teams from "plaque" to "quality improvement".

Key words: General practitioners, Team of Gold Medal Family Doctors, Primary Health Care, Policy Implementation, ROCCIPI