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NHS England's top GP resigns following Pulse comments

The NHS England director of primary care Dr Arvind Madan has resigned following his interview with Pulse.

He admitted that he had been posting provocative comments under the pseudonym ’Devil’s Advocate’ on the Pulse Today website.

In a statement, he apologised to small practices following his interview in Pulse, where he suggested GPs should be 'pleased’ when small practices closed. 

The BMA said It had written to NHS England ’raising concerns and demanding action’ earlier in the day, but it is understood that Dr Madan tendered his resignation prior to receiving the letter. 

In his interview with Pulse, Dr Madan stood by comments that ‘rationalisation’ occurs in every market, and that there are ’too many small practices struggling to do everything patients now want for their families in a modern era of general practice’.

It was later reported that these comments were originally made in the comments section of Pulse Today, 

In his statement, Dr Madan said he had ’lost the confidence of some of my colleagues’ with the comments reported in the Pulse interview. 

He said of his comments on Pulse stories: ’As part of my attempts to challenge the negative views – and even conspiracy theories – held by a small but vocal minority in the profession I posted on an anonymous online forum used by GPs.

’It was never my intention to cause offence but rather to provoke a more balanced discussion about contentious issues acting as a devil’s advocate.’

Dr Madan said his comments didn’t reflect NHS England policy, and he apologised ‘unreservedly’ to small practices. 

He said: ’In my 23 year career as a frontline GP I have worked in practices of all sizes and have always believed that smaller practices serve a particularly crucial role.

’I know they work tirelessly, alongside all primary care colleagues, to serve their patients and perform a role that goes well beyond being their doctor. GPs in smaller practices serve a particularly vital role as a point of constancy in the lives of often very vulnerable patients.’

Earlier, the BMA had sent a letter to the chief executive of NHS England, Simon Stevens, about Dr Madan. 

Dr Mark Sanford Wood, BMA GP Committee deputy chair, wrote: ’I am writing on behalf of GPC England to inform you of our serious concerns regarding both the comments made by Dr Arvind Madan in Pulse magazine suggesting that GPs should be “pleased” when small practices close, coupled with his postings under the pseudonym “Devil’s Advocate”.

’His damaging comments have caused significant anger from the profession at a time when GPs require support from NHS England.

’The key revelation from the pseudonym postings, specifically his belief that individual GPs losing their practice, and their business, is not only necessary, but something he thinks should be welcomed, has severely compromised his integrity.’

RCGP chair Professor Helen Stokes-Lampard said: ’The college has had a constructive working relationship with Dr Madan, but his comments about smaller GP practices did not land well with many of our members, and once revelations about his anonymised postings were made, we understand that he felt his position at NHS England had become untenable.’

She added that the RCGP ’looks forward to building new relationships and working constructively with Dr Madan’s replacement’.

Dr Madan was coming towards the end of his three-year secondment to NHS England from the Hurley Group Practice in east London. 

Readers' comments (52)

  • Whatever you think about them, the GMC's guidance on use of publically accessible social media is very clear - if you say you are a doctor, you must identify yourself:

    "Anonymity
    17
    If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name. Any material written by authors who represent themselves as doctors is likely to be taken on trust and may reasonably be taken to represent the views of the profession more widely.

    Pulse may be " intended for healthcare professionals only" and require professional registration details, but we should still hold ourselves to the same standards here, as we would in a face to face professionals meeting. I wouldn't say anything here that I would be uncomfortable saying to a colleague.

    I wrote about this back in 2013, when the guidance was newly released:

    http://triptogenetica.blogspot.com/2013/03/doctors-nyms-social-media-good-medical.html

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  • Let common sense prevail

    5 days ago I discovered who ‘England’s top GP’ was, courtesy of Pulse publishing his crass comments. Today he has quite appropriately fallen on his sword. Is it time for NHSE to take a good look at itself and to admit that their remit is not to support the profession, it is to drive government diktat.
    Do they really want a war with the profession, because that’s where we are heading?

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  • i would not be surprised if there was some pre planning involved in all of this , I will look out for further developments good or bad!!!

    Testing the water ?????

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  • National Hopeless Service

    Can we see Devils Advocates comments please Editor?

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  • You couldn’t make it up: what pseudonym is simon Stevens and Hancock commenting under???

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  • Less “Devils advocate” and more “Tory mouthpiece”

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  • Yes, please publish all his Devils advocates posts in one article.

    I suspect they are all about to be cleansed from the internet.

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  • Arrogant hubris from someone who is supposed to be a colleague. Cue the vile comments from the Daily Mail. I hope his partner colleagues dump him.

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  • National Hopeless Service

    http://www.pulsetoday.co.uk/53828.publicprofile

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  • Actually I have to take that last comment back, as i have just found them on google and so far I have read about a year's worth. They don't seem too controversial.

    However, the comment he has resigned over, showed a complete lack of respect for his hard working collaegues. How can he think that the majority of GPs would welcome other GPs going under. How could he think that it is acceptable for a GP to give 20 or 30 years of service to their communities and be rewarded with personal bankruptcy, just because they are the last partner left in their practice.

    If the Government has decided it wants to change General Practice, then it should be paying for the liabilities in winding up a practice. To do otherwise is to have a massive conflict of interest, namely forcing a change by deliberately underfunding the smaller practices.

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  • Time to unmask Devil's advocate - his post from 1st of May
    £2.4bn GP support package ‘remains on track’ two years in, says NHS England

    |Devil'sAdvocate's comment |01 May 2018 5:22pm

    Not sure some of these comments are entirely fair....am I the only one who got CQC paid, £1/patient for indemnity, resilience money, time for care leadership training, online consulting paid for, pharmacy subsidy and training for care navigation and correspondence handling?

    Maybe some balance is needed if we are to have a debate on whether this is enough, or the right plan here...

    My response would've been _ 'Yes, likely you are one of the rare breed who got everything.'
    Personally, for 8 years, I have not received a penny of funding and even funding for a stair lift for the disabled was denied.
    'Yes, you are the chosen one - so show your face and let us see the exceptions
    prospering from the change or the face of corruption as you might be one of those leading a CCG or LMC.'

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  • Are you having a laff! The Tory appointed NHS lead GP has alledgedly been doing a Trump/brexit/Russia on GP partners who are collapsing in droves due to the Tory govt.Please demand from Hunt and other ministers what they knew,directed and sanctioned.I am a real just retired GP but is the next comment you read a government propaganda agent?Am I being targeted as an agitator? Are you as worried as me? What other organisations are this govt using cybertactics on?...got to go now and unplug my router...where's a teenager when you need someone to counter MI5.

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  • His comments were deplorable. Why would you ever wish bankruptcy and ruin on anyone? Let alone when it's not their fault but forced upon them by politicians and a broken NHS. He should also consider his position as 'top GP'.

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  • "Britain's Top GP....." Another one who has opted out of front line clinical practice to be a government hack. He and others like him are the reason I'm off in the next 6 months, like many of my contemporaries.
    Big black hole coming soon - "They'll miss us when we're gone"

    Soon to be ex-GP 3080872

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  • I always wondered why anyone would become a salaried at Hurley Group.... why bust yourself making these exploitive clowns richer?... Gerada and co are in it for themselves and their self interests, not the patients. They are interested in money and building a big business, which I presume they'd flip at retirement. I do wonder why educated professionals are willing to become salaried underlings in these corporates? As for the title 'England's top GP'- I had to laugh- power hungry, money hungry yes.. top... nah! Its just a job that gets him away from the patients and allows him to push his own agenda.

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  • Good to know he has resigned

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  • Look and the comments on the Daily Wail.Ant GP again this chap being a hero to them.I wonder how many of those are anonymous government lakeys out to troll the public sector again.As a commenter has said in these articles the government want war with the profession sadly our Top leader are either collaborating or do not have the bottle.The ultimate casualty will be the NHS.

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  • This still leaves us with a now clearly exposed government policy to terminate with extreme prejudice all small practices.
    His successor must be constantly grilled.

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  • Time maybe to thrown in a digital recording of a Head of Primary Care where he thrice insists that he doesn't care what patients say:) Would be a timely bombshell but ten is it worth it. We all know NHSE and CCGs are full of cretins and if you raise matters, they say they are going to take it as a complaint and then after a month ask for proof or ignore it till the next time further concerns are raised. One of our senior GPs boasted they have a person in the CCG just to keep tabs on opportunities available and what's cooking? Is that why you become members or a sick ego of a retired stale GP clinging on to the limelight ostentatiously of course, 'to make a difference'

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  • Perhaps he is now Britain's 'bottom GP'

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  • Una Coales. Retired NHS GP.

    @PatrickMcnally appreciate your blog. Yes I sat down with the GMC in a roundtable to discuss updates to the GMC guidance on social media and pushed for no anonymity for doctors if using social media publicly as it may lend itself to trolling without consequences. I was a St Thomas' GP SHO for CG and AM in their Hurley clinic many moons ago. I did notice they preferred hiring salaried GPs instead of handing out partnerships and now they run a string of surgeries with predominantly salaried GPs. This model of salaried GP alligns itself with the US HMO model. I would much prefer GPs adopt the Pamela Wible MD model of independent practices like dentists, plumbers, salons, etc. Always better to be one's own boss than forever an employee.

    That said if you are a salaried GP in a lovely NHS practice that is stress free, then that is fine too as is being a freelance locum. But I have had several salaried GPs approach me for help when their bosses do not comply with employment law so I know it may not be perfect. The key to financial freedom is independence. My two cents.

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  • Sorry, I should say England's 'Bottom GP'

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  • The Hurley Group eh?

    Well, who'd have thought?

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  • Why does this person not have the right to post provocative devils advocate comments anonymously like the rest of us?

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  • Once again someone who is not a clinician or a very part time one seeing patients telling others how it is done. I hope he learns his lesson.

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  • Rather cliched but, I totally disagree with what he is saying but would defend to the death his right to say it.

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  • So saddened by this whole episode. We are under assault from all sides - even our own. And now, incredibly, Dr Madan appears in his resignation to contradict everything he said in the interview.
    The population literally does not know what a valuable resource they are losing here.

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  • Who else uses this site?

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  • This comment has been deleted

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  • I wonder how big his severance cheque is going to be?

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  • This comment has been deleted

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  • What is with this "cellars" fantasy?

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  • Hahaha hahaha hahaha
    Another one bites the dust

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  • Vinci Ho

    No surprise
    I remember Devil Advocates as well as some others. I have been saying about this platform got so famous and being monitored daily by politicians and technocrats .


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  • doctordog.

    All this power eh?
    Go figure.

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  • ''Dr Madan said his comments didn’t reflect NHS England policy, and he apologised ‘unreservedly’ to small practices. ''

    And how much do we believe this given it comes from the (until very recently) NHS England Director of Primary Care?

    Its become pretty clear through this charade what NHSE's destructive approach to General Practice is.

    Never mind Arvind- you'll probably still get a gong and a pat on the back from the Health Secretary, whilst small practices go under with all the inherent misery that causes to GPs and patients alike.

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  • He can always get a job as a consultant for one of the American health insurers looking to take over

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  • Vinci Ho

    https://www.bbc.co.uk/news/uk-45078391

    NHS England's most senior GP resigns over anonymous online posts

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  • money, money, money, must be funny....in a rich man's world....ahah, ahah-all the things I could do if I.....

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  • What a hypocrite, says GP's are overpaid, then takes his large profits from the Hurley group.

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  • He repeatedly lied. This must raise questions about his fitness to practice. Anyone brave enough to report a well-connected liar to the GMC?

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  • Took Early Retirement

    Well, he's certainly not a "Top GP" now!

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  • Apparently in Dr Madan's role as NHS Englands director of primary care he oversaw the £45 million fund for online GP consultations. Something which has led to a bumper order of Econsult software. Econsult is owned by The Hurley Group, of whom Dr Madan was until recently the CEO and a significant shareholder.

    The Plot Thickens.

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  • Knowledge is Porridge

    Having made the econsult "platform" he may really believe in it, but he should not then organise NHS funding to force econsult on us, with money going in his pocket. Very dodgy.
    Unfortunately NHS England will not want a fresh perspective, but will want "on message" input.
    Maybe someone from babylon will have an NHS England sabbatical to promote apps in general practice...

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  • Wow, massive conflict of interest. The ship is going down and there isn’t anymore who’ll save us.

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  • I wonder if he will get his appointment with De Gerada for counselling expedited, or will he have to wait in the queue like the rest of us disturbed and traumatised individuals?

    Either way, ex-director of Primary Care, in terms of your career in this post, as they say on the film-set, "it's a wrap".

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  • Googled his previous comments. There’s quite a few. I couldn’t see the one about small practices. Some of his comments could be seen as controversial but one on the feminisation of the profession could have been written by a certain senior member of GPC.
    He has been quite pro pharmacist in practice, so I can see his influence on NHSE there, and as a large practice with a practice pharmacist I will give his dues on that.
    My biggest concern is how NHSE dropped him. If NHSE are going to show so little support to “one of their own”,.... what can the rest of us expect???

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  • Una Coales, 6 August 2018, 8.47: (GMC Roundtable talks) "pushed for no anonymity for doctors if using social media publicly as it may lend itself to trolling without consequences"

    I was 'trolled' on this PULSE platform by "Monty", who has since changed his anonymous PULSE name to "PrimaryPrimate".

    I stopped contributing to PULSE after the personal attacks that I received from "Monty".

    In his posts as "PrimaryPrimate" it is stated that as a doctor he is still doing Locums and has been elected as a Tory Councillor.

    I am all for Free Speech and for freedom to talk about the good, bad and ugly, but personal abuse, undignified and unprofessional behaviours are given greater freedom when done so under anonymity. I realise this is an on-going debate.

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  • I had an interesting read of some of Devil Advocate's comments, from this page:

    http://www.pulsetoday.co.uk/53828.publicprofile?PageNo=2&SortOrder=&PageSize=20#comments

    It looks like some of the comments are there, but there is one (or maybe some) which have been removed.

    In particular a comment from 29th June 2017. PULSE EDITOR, can you confirm that there was an comment on that date, and what it was?
    I have a copy if it helps.

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  • CENSORSHIP?

    I feel sad for him..
    Good to have BME in a top role..
    I think what he actually must have meant is
    that it is a good thing that a practice closes when CQC has found numerous shortcomings which could not be resolved despite numerous attempts
    Obviously such places need support to improve
    and the truly bad places that do not want to improve must be a minority.

    He just had a corporate mentality..
    Small place closes
    big corporate takes over
    and assimilates the patients

    Survival of the fittest ??

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