See editorial "A new agency to catch underperforming or incompetent doctors was unveiled by the UK government this week, in the wake of an official report that confirmed the British GP Harold Shipman, serving life for killing 15 patients, as one of the most prolific serial murderers in history.
But the BMA pointed out that the proposed new National Clinical Assessment Authority would not necessarily detect a doctor like Shipman, and called for a series of measures to improve the monitoring of death rates among GPs' patients and drug prescribing.
The authority, set up to provide “fast track” responses to concerns about doctors, is a reaction not only to the Shipman case but to a series of medical scandals that have rocked public confidence in doctors. These include the cases of the disgraced gynaecologists Rodney Ledward and Richard Neale—struck off the medical register only after years of gross malpractice—and the children's heart surgery saga in Bristol.
The report on Shipman, published last week, suggests that he may have been responsible for the deaths of more than 300 patients in his 24 year career, first in Todmorden, West Yorkshire, and since 1977 in Hyde, Greater Manchester.
Richard Baker, professor of quality in health care at Leicester University, who drew up the 145 page report commissioned by the Department of Health, identified 236 deaths as directly suspicious, but added that the toll could be as high as 345.
The analysis by Professor Baker, an expert on medical audits, suggests that more than half the patients who died under Shipman's care may have been murdered. The 15 he was convicted of murdering were killed with injections of morphine or diamorphine, typically in their homes or at his surgery.
Professor Baker studied cremation forms and death certificates signed by Shipman and looked at the circumstances in which his patients had died.
He concluded that Shipman certified 297 “excess” deaths compared with other GPs with similar patients, although the excess could be as high as 345. Shipman, who had a conviction for pethidine misuse early in his career, was present at many more deaths than fellow GPs, and only 40% of Shipman's patients had relatives present at their deaths, compared with 80% for other GPs' patients.
Professor Baker's report recommends a range of reforms to improve the monitoring of GPs, including routine monitoring of death rates and better methods of overseeing the use of controlled drugs and the quality of medical records.
A public inquiry, headed by a High Court judge, Dame Janet Smith, will look at how Shipman was able to continue murdering his patients for so long. The BMA called on the government to take action to reassure the public.
John Chisholm, chairman of the BMA's GPs' committee, said: “Professor Baker's findings have truly horrific implications. I am determined that the medical profession will cooperate with and contribute to the public inquiry in order to prevent any possible recurrence of these appalling events.
“The public needs reassurance now, and the Home Office can take some important steps immediately to overhaul the systems for checking drug registers and for death certification.”
The BMA called for:
- All deaths occurring on practice premises to be automatically referred to the coroner
- A clear definition of the categories of death that the coroner is required to investigate
- A statutory obligation to report such deaths to the coroner
- Monitoring and analysis of death information
- Larger coroners' areas and more up to date technology, allowing local patterns of deaths to be spotted more readily
- Regular checking of GPs' and pharmacists' drug registers, with cross checking of pharmacy registers to detect whether a doctor was using several pharmacies to disguise an untoward prescribing pattern.
- The authority, which starts work in April, will investigate patients' complaints and refer cases to the General Medical Council. Ministers hope it will speed up the process, shortening the time it takes for doctors accused of misconduct to come before the GMC.
- The authority will be headed by Jane Wesson, the chairwoman of Harrogate Healthcare NHS Trust since 1993. Its medical director will be Alastair Scotland, the director of medical education and research at Chelsea and Westminster Hospital, London, and senior lecturer at Imperial College School of Medicine.
- Health minister John Denham said: “The National Clinical Assessment Authority [NCAA] is a new approach to the problem of poorly performing doctors. Instead of waiting until a problem becomes a scandal or a disaster, instead of allowing out of date procedures to grind on while patients are at risk, the NCAA will spot problems early and work with doctors and the NHS to get doctors the right support and training to enable doctors to reach a good standard of practice as quickly as possible.”
- Other reforms by the government to try to restore public confidence in the medical profession include more rigorous checks of hospital doctors and locums before they are appointed to posts. A series of cases has highlighted the ease with which doctors who have left one job under a cloud can be appointed elsewhere, with the new employers remaining unaware of their history. (See p 66.)
Copies of the report can be accessed at www.doh.gov.uk/ hshipmanpractice
