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It was later reported that these comments were originally made in the comments section of Pulse Today, 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

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

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