The scale of Harold Shipman’s crimes has inevitably meant that the subsequent inquiries have had to be as exhaustive as they were unsparing. The 1,300-page report published yesterday after Dame Janet Smith’s inquiry, the fifth into the murderous activities of the Manchester GP, is the most damning yet, and concludes that the procedures and culture of the General Medical Council are fundamentally flawed. “I have been driven to the conclusion that the GMC has not, in the past, succeeded in its primary purpose of protecting patients,” Dame Janet said. Rarely has an ancient and widely respected professional body suffered such devastating criticism.

Her report concludes that there is a perception, shared by most doctors, that the GMC should represent the medical profession. This, she rightly insists, is wrong. The GMC is a regulatory body, meant to ensure that its members uphold the highest professional standards. Its job is to root out the incompetent or those unwilling to abide by the ethical guidelines that must regulate such a sensitive profession.

Sadly, this has not been the case. All too often the GMC closes ranks when a doctor is accused of misconduct, acting in the interests of its members rather than protecting the public. It is too willing to dismiss as frivolous complaints that, admittedly, can sometimes be trivial, too ready to accept the arrogance of senior doctors who do not tolerate questioning of their methods or authority and too tied to a culture that despises whistle-blowers as sneaks letting down the side. Dame Janet had harsh words for the attitude that reporting on a fellow doctor was “not done”.

Her report does not accuse the GMC of acting wrongly in the Shipman case; indeed, it says, it followed standard procedures in suspending him after his conviction of obtaining pethidine by deception. Nor could it be held responsible for his subsequent killing spree after he re-entered general practice. But it was the perception of the GMC as a closed body that inhibited complaints and allowed him to continue his crimes for 23 years without any concern being raised. The GMC has since conducted its own investigation into this appalling laxity, and set in place various reforms. But Dame Janet is still not convinced that there has been a sufficient change of culture to ensure proper patient protection.

She makes at least 100 proposals. The most far reaching is the composition of the GMC itself. It should, in future, have far greater lay membership — an overdue change to ensure more independence from the medical profession and one which other professional bodies, such as the Law Society, have also recently implemented. Self-regulation must be the norm for professions dependent on expertise, ethical commitment and professional pride. But she also calls for periodic re-evaluation of doctors to ensure continuing competence. And she calls, sensibly, for greater transparency, a database on doctors’ records and public information on those who have been disciplined.

The likelihood of another Shipman is thankfully remote; and the Government should be wary of overreacting with new regulations that stifle professional initiative. But the GMC must take Dame Janet’s strictures extremely seriously. When doctors offend, they do more than let themselves and society down; they can destroy not only trust but life itself.

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