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GPs go forth

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It was later reported that these comments were originally made in the comments section of Pulse Today, 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

    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:

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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

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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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