Fulfilling the Astana vision for primary care as the foundation for population health will require a step change in the way primary care is organized and delivered. There is huge variation in primary care organizations – from solo clinics to city wide health centres – and no single blueprint for the future. But across the WHO European Region there is growing experience of team-based, services delivered through networks and larger primary care organizations. This paper draws on a pragmatic review of available evidence, case studies in five countries and workshops with primary care experts to describe different forms of networking, collaboration, and organizational change in primary care, identifying potential benefits that can accrue and highlighting potential pitfalls. Opportunities include teamworking, extending digital technology; improving access; integrating with other services and opportunities to develop premises and build organizational development capacity. Risks include reduced continuity and professional disengagement. The paper describes policy levers to encourage new ways of working and sets out a three-stage, practical approach to guide policy-makers aiming to encourage large-scale primary care organization that better meet the needs of population.