Conceptualising the primary health care workforce: A meta-narrative-inspired review of stakeholder perspectives in Denmark

Le résumé fourni par la source

• Stakeholders conceptualize the PHC workforce in conflicting ways • Three narratives identified: health economics, medical, and community • These narratives drive contestation over governance, tasks, and delivery • Policy reforms risk failure if they ignore diverging stakeholder perspectives • Engaging multiple narratives may support more sustainable PHC workforce policy Primary healthcare (PHC) systems across Europe are under increasing pressure. In response, research has focused on how to develop and support PHC workforces. However, studies often neglect how stakeholders conceptualise the PHC workforce, even though this may influence reform processes. Denmark offers a relevant case due to the involvement of many stakeholders and longstanding tensions over workforce organisation. To examine the literature on how stakeholders in Denmark conceptualise the PHC workforce and how conflicting narratives influence policy contestation. We conducted a meta-narrative-inspired literature review, following RAMESES guidelines. The review included 49 sources (1980–2025), drawing on peer-reviewed articles, organisational documents, professional journals, policy texts, and political news. Documents were screened, appraised, and synthesised using an iterative narrative analysis. We identified dominant stakeholders, primary narratives, and key areas of policy contestation relevant to the PHC workforce. Across 45 years of reform and policy debate, three primary narratives have structured stakeholder perspectives: a medical narrative emerging in the mid-1960s, a health economics narrative gaining prominence during the 1990s, and a community narrative growing since the early 2010s. These narratives compete across and within stakeholder groups, most visibly in debates over governance, task-shifting, and whether recipients are framed as patients or citizens. Stakeholders in Denmark conceptualise the PHC workforce differently depending on the narratives they invoke and the reform context in which they act. Reforms are more likely to gain traction when engaging these perspectives. Narrative-informed approaches can help anticipate resistance and support more effective PHC workforce development.

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