GIS-supported territorial redesign for proximity-based primary care in Reggio Emilia, Italy

Primary care reforms can remain organisational rather than territorial: new units are often mapped onto inherited areas that may not reflect geographic accessibility. In heterogeneous urban, rural and mountain territories, proximity risks remaining a vague principle unless translated into operational planning criteria. In 2025, the Local Health Authority of Reggio Emilia, Italy, used the implementation of Aggregazioni Funzionali Territoriali (AFTs), new territorial units for GPs, to redesign previous primary care areas around Community Health Centres (CHCs). The redesign combined population aged over 14, GP distribution, existing and planned CHCs, related territorial services and travel-time mapping. OpenRouteService generated walking, public transport and private car isochrones. In the urban area, 15-minute isochrones informed neighbourhood-level proximity analysis; in mountain areas, longer travel-time thresholds accounted for topography, road networks and settlement patterns. Geographic accessibility was operationalised as one measurable component of proximity, integrated with demographic balance, workforce distribution and local service networks. The process led to the implemented province-wide reorganisation from 23 previous primary care areas to 19 AFTs. In Reggio Emilia urban area, neighbourhood and populations were combined with travel-time maps to define 5 urban AFTs close to 30,000 residents aged over 14. In the mountain district, a single AFT was rejected because of excessive centralisation, 2 AFTs were defined instead. The final configuration had a mean of 25,659 residents aged over 14 and 16 GPs per AFT. GIS-supported planning helped translate proximity into an explicit territorial design criteria. Its value was not technical automation, but a transparent assessment of accessibility, population balance, workforce distribution and local geography. This approach may support equitable primary care redesign in urban, rural and mountain settings.

Key messages

• Equity-oriented primary care planning requires geographic accessibility to be combined with population needs, workforce distribution, urban-rural diversity and local service networks.

• GIS-supported planning can translate proximity from a policy principle into a practical tool for redesigning primary care territories and comparing alternative scenarios.