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.

To systematically identify barriers to the development of Gold Medal Family Doctor Teams and propose optimization strategies.

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).

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; (4) on the basis of policy standardization and public communication, explore pilot programs for paid service packages.

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".

家庭医生团队是居民健康的关键守门人，然而其发展普遍面临签约形式化、能力与资源错配等瓶颈。天津市将打造"金牌家庭医生团队"建设列为2025年民心工程，但其政策执行效果与设计初衷存在落差，亟待系统诊断。

系统识别金牌家庭医生团队建设障碍并提出优化方案。

于2025年5—10月，结合相关文献和本研究的目的制订访谈提纲，采用目的抽样法收集资料，对20位专家进行半结构化访谈，并按照ROCCIPI框架[规则（Rules）、机会（Opportunity）、能力（Capacity）、沟通（Communication）、利益（Interest）、过程（Process）和意识形态（Ideology）]进行问题识别。

分析发现问题并非孤立存在，而是源于3组深层矛盾：在制度层面，行政推荐与激励脱钩导致金牌含金量不足；在运作层面，固定配对的支援模式与碎片化的信息系统难以支撑实际服务需求；在组织层面，团队缺乏自主权且成员负担过重，导致服务难以做实。这些矛盾相互交织，制约了金牌团队应有的标杆作用。为此：一是建立"动态认证、荣誉挂钩"的成长性激励机制；二是构建"专科资源池与智能转诊平台"相结合的弹性支撑体系；三是赋予团队更大自主权并配套过程化管理工具；四是在政策规范与公众沟通基础上，探索有偿服务包试点。

本研究基于关键知情者证据提炼出"评选与激励""支撑与协同""组织与赋能"三组可迁移的矛盾结构，进而构建与之匹配的政策工具组合，为标杆型基层团队政策从"授牌"走向"提质"提供可操作的机制解释与干预路径。