Ontario is considering major changes to its $50-billion health care system, including monitoring the performance of doctors, who are already fuming over fee cuts imposed by the Liberal government.

A Ministry of Health discussion paper suggests an expanded role for Liberal-created Local Health Integration Networks (LHINs), and shutting down the Community Care Access Centres created by the previous Conservative government.

Earlier this month, auditor general Bonnie Lysyk found none of the 14 LHINs had ever met all of the targets in 15 performance areas, and the Liberal government responded by relaxing the targets for some of them.

The new discussion paper says the LHINs would be responsible for "planning and performance management" of family doctors.

They would also "govern and manage the delivery of home and community care" as the government diverts funding away from hospitals to pay for more services at home or in clinics.

The paper suggests that home care coordinators could be used at community health centres, Family Health Teams and hospitals, and wants a more co-ordinated and easier to navigate system.