Those are enormous questions, the kinds of questions the president of the CMA should be answering, as he's much more experienced than I am. I can only speak to a portion of that, and you might want to pass the question to John, if that's okay.
Several links are not occurring. Speaking for the specialists, the specialists are not responsive to the family physician. So if family physicians or CCAC case nurses have an issue that needs to be dealt with quickly at the specialist level they cannot get in, they cannot get help. The word I kept writing down as I heard it at the different talks is “accountability“: there's no accountability or responsibility on the part of many of the sub-specialties.
We keep waiting lists, we make sure patients flow through, but we have no responsibility to see that particular patient at that particular time. There's a real disconnect between outpatient clinics and in-hospital clinics. There needs to be some way to join these specialists who are in hospital with the specialists who are out of hospital and make sure they are readily accountable to family physicians, CCAC, community care access centres, and that they have rapid access to those areas of expertise.
That's my little piece of the puzzle, but I have to defer on the rest of your question to people who know more about the greater system.