Background: An implementation framework for community-oriented primary care (COPC) was developed in the Cape Metro, Western Cape Province, South Africa. In 2018, four learning sites were identified to experiment with the framework. A study was undertaken to explore the implementation of this framework. Objectives: To explore the process and progress of implementation, as well as the perceptions of the barriers and enablers of implementation. Methods: A programmatic process evaluation with a descriptive exploratory qualitative study design was used. A logic model was developed, and defined inputs, outputs and the sources of evidence for the implementation process. Results: The understanding of COPC and its underlying philosophy contrasted with the traditional model of care, and the paradigm shift was challenging. Strong leadership was identified as a facilitator for change. Community and stakeholder engagement were the most challenging issues. COPC requires a wide range of skills and expertise supported by appropriate training and clear role definition. The use of electronic devices in the community was both an advantage and a barrier. Conclusion: Implementation of COPC needs to be understood as a reform of the model of care, and not as an additional project or service. The findings can guide policy, further scale-up and implementation of COPC.