Dr Harold Shipman was a trusted family doctor, yet it turns out that he was not to be trusted to a lethal degree.

The GP from Hyde in Greater Manchester has been exposed as Britain's most prolific serial killer following his conviction for killing 15 elderly female patients.

There are a number of possible responses to this appalling case. Before considering those, it is important to stress that patients should still feel happy and safe about visiting their family doctor. A consultation that might detect an illness or complaint is always going to be vital.

Yet while it is stating the obvious to say that Harold Shipman was a one-off case, it would be complacent to assume there are no lessons to be learned. Equally true, it is important not to over-react and introduce further layers of stifling bureaucracy in a series of panic measures.

The expected inquiry into the Shipman case should consider a number of recommendations for change. The West Pennine Health Authority where Shipman practised points out that no system could stop a determined killer, yet there are a number of obstacles that could hinder any doctor possessed by a similar twisted purpose.

Harold Shipman worked alone in a single-handed practice. He was a one-man operation and so it was easier for him to evade scrutiny. Had he been part of a group practice, one of his doctor colleagues would surely have suspected that something was amiss. Five of Shipman's patients died on his own premises, which is an unheard of number. Another doctor would have been alerted by such an alarming statistic. It would also have been harder in a group practice for Shipman to have stockpiled the drug he used to kill so many patients.

Another possible reform concerns the certification of death. Cremation already requires an examination by a second doctor, yet this is often cursory. Greater safeguards need to be introduced.

We hope never to see another Harold Shipman. But if such a murderous doctor ever does exist, he should be exposed by the system at an early stage.

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