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  1. R Neighbour
  1. President, Royal College of General Practitioners, 14 Princes Gate, Hyde Park, London SW7 1PU, UK;

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    Harold Shipman was a murdering psychopath on an unprecedented—let us hope unique—scale. Because he was also a general practitioner, he had more than the “average” murderer’s means and opportunity to commit his crimes. Equally importantly, he was able to capitalise on the assumption of trustworthiness which society makes about its doctors. Even if the likelihood of another Shipman is vanishingly remote, it behoves everyone to cooperate in measures of risk assessment and primary prevention on a correspondingly unprecedented scale.

    On the other hand, over 30 000 general practitioners do not murder their patients, do not abuse their professional position or betray their trustworthiness; they are entitled to feel hurt by any implication that they might. One can understand ordinary doctors, while not condoning the laxities that allowed Shipman to escape detection for several decades, nevertheless resenting the fall-out if it seems based on the assumption that all general practitioners are under suspicion until proved otherwise.

    There is therefore a balance to be struck between under-reacting and over-reacting to the Shipman outrage and I am not sure that Richard Baker has quite found it.

    Many of the recommendations expected to flow from Dame Janet’s Inquiry are non-contentious and long overdue: tighter certification procedures, establishing a culture of vigilance, more thorough checks on doctors displaying known predictors of criminality such as drug dependency or falsification of records. But, as Richard’s piece confirms, there is a risk that a number of other issues, peripheral to the Shipman case, will highjack the agenda in the name of “safety”, and bounce us into hasty and ill considered proposals that could antagonise the very doctors on whose support they depend for their success. I’m thinking particularly of quality control initiatives such as appraisal and revalidation, and programmes already begun to update the concept of professionalism in a more patient centred way.

    Richard Baker suggests that restricting the post-Shipman debate would limit the opportunity for improving medical practice, and renege on the duty owed to the victims. I disagree. The agenda of improving the quality and safety of medical practice does not need to ride piggy-back on one disaster, no matter how extreme. It is an ongoing and self motivating exercise in its own right, and should be allowed to make its own case on its own merit. If the legacy of Shipman were to be the demotivation and paralysis of general practice through over-regulation—that would be the real betrayal.