Health economist Professor Alan Maynard imagines the contents of a memo from the Prime Minister to Jeremy Hunt

Dear Jeremy,

As you seem to be experiencing some local difficulties, I felt it was incumbent on me as your Prime Minister to offer some advice and how we might proceed with NHS and social care matters.

Social care problems
As you know, I am rather lazy and do not keep up with the minutiae of policymaking. Consequently, I was surprised to discover from local authority colleagues in Oxford about the scale of the cuts they are facing.

Of course I would normally ignore such trivial bleatings if it wasn’t for the potential political fallout locally and the fate of the private care home sector in which so many of my good friends have invested.

It seems that the effects of local authority funding being cut by circa 25 per cent in the last five years is reducing social care funding. As you know, we abolished the Local Government revenue equalisation formula in 2012. This has enabled us to be more generous to our friends in the shires and ensure unsympathetic Communist-inclined bounders such as Liverpool experience much more severe cuts

We have redistributed some NHS funding to social care through the Better Care Fund. However, unsympathetic critics have dubbed this the Better Care Fraud and that cheeky fellow Simon Stevens at NHS England has begged that such damaging NHS policies be not repeated in 2016-17.

With the Living Wage and demographic trends accentuating social care problems, we have to ensure that my hedge fund friends, who so wisely invested in private care homes, are given access to suitable profits.

Could you and whoever is in charge of Local Government cuts have a hard talk with George? He may be more willing to be helpful after his tax credits black eye!

General practitioners
I was very bored yesterday so read the Manchester survey of general practitioner attitudes. It started off so very nicely: showing that they have reasonable income stability, moderate hours of circa 40 per week, and marginal reductions in their administrative burdens.

However this satisfactory material was then undermined by an array of qualitative data showing that the wretches were really fed up with their professional lives.

This comes after my wonderful manifesto pledge of 24/7 i.e. in order to prevent continuing mass slaughter in hospitals and primary care; I undertook to invest in more doctor and nurse cover at weekends.

Indeed I gave you £50 million to fund GP pilots offering weekend access. The bounders have now shown that subsequent patient attendances were pathetic; due in part I have been told that hard-working families prefer shopping and attendance at football matches rather than take their drivelling noses to GPs!

As you will know Jeremy I was not pleased by this outcome. Despite your advice to ignore data, which we are all good at, I sought advice from one of these expert blokes, and I liked neither his attitude nor information

Basically he accused me of being a silly-Billy, who should have looked at patient demand before wasting public money. He then went on to elaborate what was concerning GPs.

Firstly, he reported that case mix in general practice had changed substantially. The use of nurses and other ancillary staff has taken simple cases away from GPs, leaving them with increasing numbers of ageing patients with complex multi-morbidities.

Secondly, hospital referral systems are increasingly demanding with rigid protocols requiring initial work-ups, which, if not provided, are leading to referrals being declined.

Finally this damnable expert explained that you and I are too inclined to moan on about quality. For instance you, Jeremy mentioned Mid-Staffordshire hospital 16 times in a recent Select Committee hearing. It seems that we should emphasise caveat emptor i.e. buyers should beware and “adverse events”, are unavoidable, whilst all the time it is essential to minimise carnage.

Could you be more tactful, Jeremy?

Also could you mention over dinner with Rupert the need to cool The Sun and Rothermere to shock Mail readers with some greater balance in their coverage? Here’s hoping that may be possible!

The message for GPs is that we must be nicer to them. We must devise a case mix measure to evidence the increasing complexity of primary care. Also, given the high cost of hospitals, we might pass community care to primary care providers.

However such tokens of goodwill, our expert tells us to offer to GPs, should be accompanied with payments for practices to merge. For instance: any new funding should only be provided if back office facilities are merged to cover populations in excess of 300,000. Data systems should be unified, and comprehensive national data should be provided to manage patient needs better.

I suggest you get this expert to make these proposals, and give him a knighthood if he survives the ructions from these private sector entrepreneurs, many of whom perform miracles of good patient care.

Sundry concluding matters
With regard to 24/7 care in hospitals, we need to shelve the discussions ever so quietly by appointing a retiring Royal College President to spend 12 months reviewing the evidence and enabling us to get out of this expensive hole we have dug for ourselves. Ensure that he comes to the right, face-saving conclusions, reduces panic about weekend care and is given a Tory peerage for his fine work.

NHS workforce policies are a shambles, or so I am told by my friendly expert over some excellent claret. Physician assistants bought in from the USA at £50,000 a time seem a flavour of the month. Do inquire whether they are complements or substitutes for doctors.

Finally let us remember our vulnerability. I want a few more years of leisure in Number 10, with George running the show. You want to avoid either Northern Ireland or premature un-gonged access to the back benches with fat consultancies.

So onwards and boldly upwards, my dear friend!

Best wishes,

Dave