Dr. Arvind Madan, Director of Primary Care at NHS England, signed up to Pulse magazine under the pseudonym 'Devil's Advocate', and frequently commented on news stories, suggesting family doctors were lazy and gluttonous. His posts frequently prompted dozens of angry replies from fellow doctors. On August 5 NHS England's website published a statement from Dr. Madan announcing his resignation.
"It's clear to me, sadly, I've lost the confidence of some of my colleagues, and have therefore decided to resign my NHS England position. 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 offense but rather to provoke a more balanced discussion about contentious issues," he wrote.
He went on to stress "categorically clearly" his comments are not a reflection of NHS policy.
Not So Anonymous
The true identity of the prolific 'Devil's Advocate' profile was exposed by eagle-eyed readers when Dr. Madan was interviewed in Pulse magazine — under his real name — August 1, and made severely incendiary statements that closely or even directly echoed those made by the account.
I want to ask @arvindmadan, given your statements in @pulsetoday — is your viewpoint which may become @NHSEngland policy, influenced by your role in the Hurley group? How can we- the public, be assured there is no conflict of interest?#GPcrisis #NHShttps://t.co/lHft77Y96s— DrGandalf (@drgandalf52) August 1, 2018
In particular, Dr. Madan said GPs should be "pleased" when small practices closed, as there are "too many" struggling to meet patient demand. This strongly recalled a posting by Devil's Advocate in June, in an intense comments section debate on GPs' pay. The profile chastised those complaining about their wages, stating "we can get six figure salaries for working four days a week 45 weeks a year without being on call…run that past the general public and see how much sympathy you get".
A month prior, Devil's Advocate also welcomed news 450 GP surgeries had closed down in five years, stating "most businesses" would view such a "rationalization of their market" positively, as it makes those remaining "more viable". These closures have resulted in over one million patients having to find new doctors, and stretched remaining practices to breaking point in some English towns.
"The thing everyone forgets in defense of small practices is variability and quality control. Yes there are some good / great practices out there, but there are a lot of rubbish ones — no continuity of care — high prescribing — high referrals — poor access — reactive not pro-active — it's the shame of our profession," Devil's Advocate wrote in March 2017.
@arvindmadan @MarkSanfordWood@rvautrey@HelenRCGP@BMA_GP@cgps_gp— Shaba Nabi (@ShabaNabi) August 1, 2018
No — I am not pleased. I am bloody furious.
I am grieving with denial, anger and sadness, but never acceptance.
GPs should be ‘pleased’ when small practices close, suggests NHS's top GP https://t.co/gjr5kg6hrN
The interview was extremely unpopular with public medical professionals and bodies in the UK, and led to the British Medical Association writing to NHS chief Simon Stevens "raising concerns and demanding action".
"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 individual GPs losing their practice, and their business, is not only necessary, but something he thinks should be welcomed, has severely compromised his integrity. We feel posting in this way is unacceptable for someone in his position and urge you to ask him to consider whether he can continue [in his post] having lost the confidence of the profession," the BMA wrote.