Proposals to “fix” Canada's primary care crisis by expanding the workforce or scaling up interprofessional teams risk repeating past failures. The deeper challenge lies in structural fragmentation, the absence of coherent system design and weak accountability. Sustainable transformation requires more than piecemeal reforms or pilot projects. It demands implementing a systems approach that is premised on a consensus-based, pan-Canadian strategy anchored in shared aims, principles and investments in the structural attributes of high-performing primary care systems. These evidence-informed attributes are identified in the Aggarwal–Hutchison framework. Without meaningful structural reform, new spending will yield only incremental gains, keeping Canada bound to Ixion's wheel – a self-inflicted cycle of crisis, renewal and disappointment.

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