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The non-sided contract
14th Feb 2006
John Chope wonders what makes a successful social contract and whether the new GDS contract can survive. HG Wells declared that ‘The Social Contract is nothing more or less than a vast conspiracy… to lie…for the general good.’ He claimed that ‘Lies are the mortar that bind the savage individual man into the social masonry.’ Lies are a shaky glue for any structure. Maybe this was what Margaret Thatcher meant when she denied the very existence of society. A gloomy view Clearly Wells thought that the concept of people co-operating for the benefit of society was no more than a deception which would inevitably lapse into anarchy. A gloomy view, but perhaps based on a studied reflection of human nature. In the eleventh century, King Canute understood the limit of man’s influence when he demonstrated to his ministers the folly of countering the power of the sea. It was this recognition of natural forces at play that coloured Wells’ cynicism. In essence Wells was suggesting, sooner or later, man will show his true colours: his natural selfishness that is a basic element of his survival kit - a selfishness that will support the family or even the tribal group but never an intangible concept such as society. Secret of success Wells was right about the incorrigibility of human nature but was wrong to dismiss the social contract as a myth. Neither is it based on lies. It has been fashioned by thoughtful and far-sighted individuals in succeeding generations. And what was the secret of their success? Canute knew the answer. Go with the flow, he said. The social contract relies on people and can only work if it complements the way people think and behave. In other words, go along with human nature and you will even be able to change society; go against it and you are bound to fail. That’s why the new GDS contract cannot possibly work. Ralph Waldo Emerson wrote, ‘All sensible people are selfish, and nature is tugging at every contract to make the terms of it fair.’ The trouble with the new GDS contract is that it is fair to no-one, has had no chance to do its tugging and instead is full of unresolved conflicts between the parties. Conflicts that will poison it the moment it leaves its womb at the Department of Health (DoH). List of conflicts The list of conflicts is well documented: the system for crediting UDAs to the dentist conflicts with the patient’s desire for best value for money and maximum treatment in the relevant charging band; the disincentive for the dentist to collect patients’ charges conflicts with the PCT’s rigid funding budget; the patient’s desire for a preserved dentition conflicts with the derisory UDAs for prevention or endodontics; the patient’s idea of comprehensive care conflicts with the concept of clinical necessity; the financial advantage of delaying treatment until it becomes an emergency conflicts with the concept of continuous care. A win/win A successful contract, to quote the jargon, needs to be a win-win. Yet this one achieves the almost impossible feat of scoring no wins. It is not even a one-sided contract. It is non-sided. No-one benefits. It introduces new destructive tensions between dentist and patient that most of us could have hardly imagined. Rather than employ human nature to achieve success, it flies in its face. King Canute was right all along.
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