After nearly fifteen years of evolution, China's family doctor contractual service has progressed from initial pilot trials to a phase of rapid expansion, achieving system creation "from scratch", optimizing institutional structures, and swiftly extending coverage to the target population. It has now entered a stage of high quality development, focusing on thorough and refined implementation. The rollout of this initiative has contributed positively to raising residents' health literacy, effectively managing the incidence and progression of chronic diseases, improving overall public health, and advancing health equity. Nevertheless, practical challenges remain, including workforce shortages, insufficient operational dynamism, constrained service offerings, and less than ideal user experience. To address these issues, this paper puts forward a blueprint described as "one core, two boosters, three mechanisms, and four outcomes". Specifically, it proposes consolidating the central role of contractual services, strengthening the dual pillars of capability and motivation, reinforcing the three mechanisms of training, collaboration, and incentives, and enhancing the four outcome dimensions: health status, cost containment, sense of benefit, and public recognition. This framework offers a decision making reference for advancing the construction of family doctor contractual services in the context of high quality development.

我国家庭医生签约服务经过了近十五年的发展，经历了从最初试点阶段与快速发展阶段，实现了"从无到有"的制度体系建设、机构内部架构调整与签约人群的快速覆盖，并步入了签约服务做实、做细的高质量发展阶段。我国家庭医生签约服务的实施，对于提升居民健康素养、有效控制慢性病发生发展、提高居民整体健康水平、提升健康公平性等方面发挥了积极作用。然而，当前仍然面临有限的队伍、有限的活力、有限的服务与有限的感受等现实困境。为此，本文提出了"一体、两翼、三机制、四产出"的蓝图构想，即做实签约服务核心本体、提升能力与动力两翼、加强培训/协同/激励三大机制建设、推动健康/费用/获得感/认同感四大产出，为推动高质量发展背景下家庭医生签约服务的建设提供决策依据。