Without throwing off current storylines where they'd make no sense, how would you alter the show?
I'd have Dillon return, thus ending Tracy wasting her time on lulu, and have him pair up with Spinelli as buddies. He'd befriend Maxie (as Georgie's grieving sister, of course, and they'd bond over missing her) and it'd help Maxie see how great Spinelli is as a romantic partner.
The show would be so focused on those 3 that there'd be a day -possibly even 2 in a row- without whiny lulu and the whole world fawning over her.
Sam would become pregnant and, though unplanned, it'd be Lucky's first biological child and they'd bond over that. This would actually lead to a baby and we'd see Lucky juggling 3 kids, how that'd change things with Liz, and how Sam would remain independent/kick-ass while still being a mom.
Some new chick would show up (a patient maybe) just long enough to make robin worry about Patrick disappearing and she'd move in, thus finally ending the round and round and round motion of their storyline that's been making the rest of us sick for months. The baby would be born and not end up with some totally stupid name in an attempt to throw back to something in GH's history, as if they ever acknowledge the show's past except in such moments.
Carly would turn up pregnant and thus cause Jax to try to work it out (truly try, not just get in a few fights and leave) and Carly would be too morning sick to play her usual games, thus giving them a fairly normal relationship. Kate would recognize that the baby needs both parents and quit butting in, thus leaving her with Sonny. Carly would be too busy being pregnant and happy to spar with Sonny and each would actually thrive independently of each other, without Carly or Kate being forced to be submissive whiners because they've got men.
Carly would then find herself trying to fit in at a mommy and me class, totally out of the loop, until Sam walked in with her infant, followed by robin and hers. The three would begin to bond, causing Carly to become more dimensional with actual female friends. This would then allow for holiday gatherings for the Spencers together, what with Carly and cousin Lucky's partner to be buddies. It would also allow for gatherings of Carly/Jax/Morgan/Baby and robin/Patrick/baby/Mac/Maxie, which would be fun (Carly trying to be friends with Maxie though she's lulu's cousin, Mac trying to forget how often he's arrested Carly, etc.).
With everyone else in town so busy getting along, building relationships, and furthering their careers, Johnny would realize how stupid he's been for wasting his time with the vapid narcissist and leave her. He'd be so self-loathing for wasting that time that he'd go into therapy but need his sister to come with (for support, of course) and she'd get help too. Since Laney never seems to be at work, they'd end up seeing Dr. Kevin Collins, who would sometimes be distracted by Lucy, whom he's still in love with (since we're to pretend PC never happened and thus she never married Ian who's now off being Zach who is the father of a baby named Ian on AMC). After a while, she and Ric would get together, both becoming better people for real and for long-term, allowing for holiday gatherings including Sonny/Ric and Sonny/Claudia moments of awkwardness over cooking or serving meals.
In an attempt to get Lucy to leave Kevin alone long enough to work for his many many hours "fixing" Claudia, she'd get involved with the hospital charity events and bring back the Nurses' Ball, with help from Bobbie. (To cut costs for the production of this, the viewers graciously let the writers know that we would be willing to go months or even a year without a random explosion, fire, or storm.)
AIDS awareness and money are raised with Nurses' Ball performances by Sonny singing Frank Sinatra (Kate tries to help, her accent comes out and her history is revealed but no one cares), Anthony singing "She Thinks my Tractor's Sexy" (no real reason, just funny), and then when lulu goes to perform, the meal will be served, thus proving that, when you're a vapid narcissist, even your charity work isn't worth people's attention. Lots of money will be raised, great gowns worn, and a fun time will be had by all.
*roll credits*