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A faulty production line

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It was later reported that these comments were originally made in the comments section of Pulse Today, 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

  • 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:

    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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    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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