NHS England director of primary care Dr Arvind Madan resigned on 5 August following controversy over inflammatory online comments.
Dr Madan was appointed as NHS England director of primary care in October 2015 and part of his remit was to design and implement the General Practice Forward View.
So why did Dr Madan decide to resign? Here is a summary of his final turbulent days as NHS England’s top GP.
The straw that broke the camel’s back
On 1 August, our sister publication Pulse published an interview with Dr Madan, in which he stood by comments that were previously attributed to him, where he said that ‘most businesses are pleased’ to see smaller practices close.
In the interview, Dr Madan also failed to dismiss comments where he had said that practices should take some blame for failing to recruit practice staff.
He told Pulse: ‘There are lots of factors that are within the control of individual practices around how much pay, how much flexibility and how much individuals are made to feel part of a team with a purpose.’
‘Encourage providers in a positive way’
On 2 August, following Dr Madan’s Pulse interview, the BMA wrote to him, requesting that he clarify his comments and ‘reassure smaller practices’.
The BMA asked him to make clear that he considers the contribution made by smaller practices valuable ‘but that any moves to encourage providers to work together will be done in a positive way by forcing them to fail’.
In the interview, Dr Madan told Pulse that NHS England was helping practices to join forces by encouraging them to work as primary care networks and share resources.
He said: ‘Not only will this help us manage the workload, but it also means patients can get their care closer to home and, where appropriate, out of hospital.’
Dr Madan apologised for his comments in a bulletin to GP practices sent by NHS England last week, saying he was committed to helping smaller practices ‘thrive’, adding that it was neither NHS England’s nor his view to that GPs should be pleased when smaller practices close.
However, momentum was already building around his comments, leading to pressure group GP Survival writing an open letter to NHS chief executive Simon Stevens and health and social care secretary Matt Hancock on 2 August.
The group called for Dr Madan to be dismissed from his role as director of primary care.
They wrote: ‘Dr Madan, while working as a partner in the Hurley Group, one of the largest practices in England, has demonstrated a clear conflict of interest in expressing his ambivalence to support smaller practices and may stand to benefit personally by pursuing an agenda of small practice merger and consolidation for the Hurley Group.’
NHS England said Dr Madan handed his contract back on 4 August and confirmed his decision to leave on 5 August, before the BMA wrote to NHS chief executive Simon Stevens about Dr Madan’s role – which it did on 5 August.
BMA GP committee deputy chair Dr Mark Sanford-Wood said: ‘We have today written to NHS England raising our concerns and demanding action after Dr Madan’s damaging comments caused significant anger amongst the profession at a time when GPs require support from NHS England.
‘It is only right that he has therefore done the right thing and offered his resignation.’
In a statement on NHS England’s website, Dr Madan wrote that he decided to resign after realising he had lost the confidence of some of his colleagues.
He added: ‘I am proud of what we achieved so far and sorry that I am unable to help see it through.
‘The main focus of my work at NHS England has been to help design and deliver the General Practice Forward View. I remain convinced that, as it unfolds, it will form the foundation for transformation.’