The 2010 General Assembly of the Presbyterian Church (USA) appointed a "Commission on Mid Councils" to study and recommend ways in which to adapt the structures of the denomination to current realities. The commission completed its report prior to the meeting of this year's General Assembly, which you can read (here) if you are interested. It is a long, detailed report, which will certainly be important to future historians when they write their histories of the mainline church in the early 21st century.
On page 14 (lines 7-13), the report states, "Our data clearly shows that many Presbyterians are calling for a shift from the top‐down model of our current structure to a model that is characterized by a church‐wide commitment to build up and support local congregations. Generally, congregations do not feel well supported by General Assembly agencies. Only 26% of session‐level respondents rated the Office of the General Assembly (OGA) "excellent" or "very good" and only 33% gave those ratings to General Assembly Mission Council (GAMC). There is a significant disconnect between local congregations and the agencies of the General Assembly."
I should say before anything else that it is easy for me as one who has not been involved in this process to stand on the sidelines and comment. A great deal of time, effort, and prayer went into the report, which was devoted to listening to the concerns of Presbyterians across the church. It is not fair to simply dismiss that time, effort, and prayer as wasted, even in the face of the fact that the 2012 General Assembly rejected the recommendations of the commission almost entirely (see here).
That being said, it seems to me sitting here in a quiet, distant corner of the denomination that investing huge amounts of effort in trying to reform national and regional church structures almost certainly isn't going to get us anywhere. Where the PC(USA) and the other mainline churches will live or die is in the trenches of their local congregations and nowhere else. It is time, then, that congregations and their leaders work out for themselves the relationships, connections, and real-time structures best suited to their needs. As a humble example, four churches at the northern end of Utica Presbytery, New York, have taken action in the last 18 months to develop a cooperative partnership that may lead in the near future to a formal agreement to share resources. All it took was for the two of the pastors involved to decide to "do something" and begin the process of consultation with their own sessions and the other churches. In fact, these four churches are creating their own "missional structure" without benefit of General Assembly studies, reports, and debates.
One of the recommendations of the commission report was to establish experimental "non-geographic" presbyteries, something more conservative Presbyterians would like to see happen so that they can work together in like-minded presbyteries. Instead of going through a big institutional struggle, those folks who want to start working more closely with other churches of a like theological mind should just start doing so. Get together. Do things together. Start your own projects and programs. Don't waste your time trying to change a whole denominational structure, which unsurprisingly is refusing to be changed for your convenience. It is well past time that church leaders at every level of the church stop investing vast amounts of time doing things that don't really matter any more. It is time to do what needs done and not worry about how those things fit into the larger structures of the church.