Access to primary care is poor, with high rates of unattached patients, staff shortages and a large pool of physicians likely to retire in the coming years. Enhancing the productivity of clinicians and empowering patients through digital tools is now plausible with the advent of AI tools to assist with documentation, process automation and decision support. Achieving this potential will require structures that enable the co-design of the tools, the teams that use them and the new routines they will support. Addressing this crisis will require building better tools and rethinking how primary care clinicians and patients and caregivers work together. We will use a series of case examples to explore the ethical and operational aspects of turning the hype into accessible and sustainable services for all.