Health systems across Europe are under increasing pressure to shift care outside hospitals and into community settings. The emphasis is on providing high-quality, coordinated care for a growing population of older patients and those with long-term conditions. Extended primary care is regarded as the key means of achieving such a shift. We report learning following exploratory visits to two sites in Italy, each providing an example of a primary care organisation with extended general practices, community health and local resource utilisation responsibilities. We draw out three areas of potential interest – shifting care from hospital to community settings, facilitating localism and enabling stable leadership – all of which appear to provide a means for local clinicians, managers and their communities to commission care according to local needs. We conclude by recommending that primary care researchers consider undertaking further work in Italy, building on this exploratory work and more systematically exploring the effects of such programmes.