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  1. G Catto
  1. President, General Medical Council, 178 Great Portland Street, London W1W 5JE, UK;

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    As I write these words, in the immediate aftermath of Shipman’s apparent suicide, there continues to be considerable public interest in the case and debate about its legacy. Few would argue with Professor Baker’s thoughtful and balanced analysis that its significance goes much wider than the stark, shocking, wickedness of an individual doctor who was able to kill at least 215 of his patients before being detected.

    Professor Baker wisely warns against the risk of over-reaction, pointing out that all the signs suggest that patients still trust their doctors, despite Shipman. He is right to argue that a general attitude of mistrust between doctors would be a sad, destructive development. My own view is that the ongoing implementation of robust clinical governance locally, improvements in the monitoring of the use of controlled drugs and reform of arrangements for death certification and the investigation of death by coroners should stop another Shipman. Revalidation will contribute to that overall framework, but it has not been devised as a means to detect a devious, ruthless, and determined serial killer and that must not become regarded as the test of its effectiveness.

    But while Shipman was a gross aberration, that does not mean that there are not wider lessons to be learned for everyone involved in monitoring or regulating (the two are different) the practice of doctors. It is important that the profession can demonstrate to patients, principally through revalidation, that doctors are up to date and fit to practise. I also fully endorse Professor Baker’s view that the doctor-patient relationship must become more open and straightforward, and be made less prone to the manipulation and paternalism which featured so strongly in Shipman’s practice. This is at the heart of the General Medical Council’s thinking as we take forward the delivery of our reform programme.

    With our lay membership recently increased to 40% we are uniquely placed to take forward the development of a framework of values and ethics for doctors, which is both owned by the profession and reflects the views and expectations of the public. Parliament, which in 2002 approved the legislation enabling us to implement our reform programme, has entrusted the General Medical Council to undertake this challenge. That is what we are now delivering.