The conviction of the Manchester GP, Dr Harold Shipman, for the multiple murder of his patients raises legitimate questions about the accountability of GPs and the monitoring of doctors' performance.
There can be no doubt also that these calculated killings by Shipman will damage the inherent trust which is an essential element in the relationship between a doctor and his patient.
Many people will have asked themselves if such a case could occur here. The theoretical answer is, yes. Of necessity, we invest such trust in our doctors that no amount of monitoring could prevent a determined murderer from injecting a lethal drug into a patient.
However, that is not to say that the present system of monitoring and accountability is adequate. Indeed, there are lessons to be learned from the Shipman case.
Shipman first had problems in 1976, when he began to self-medicate with pethidine, an injectable opiate. He forged prescriptions to feed his habit. His GP colleagues reported him to the General Medical Council, and he was found guilty of professional misconduct.
Curiously, he was not struck off the medical register; the GMC ordered Shipman to undergo treatment but did not restrict his licence to practise. This allowed Shipman to move to the Hyde area and to re-launch his professional career.
The question of the GMC and, indeed, our own Medical Council monitoring the subsequent performance of any doctor found guilty by them of professional misconduct must now be addressed.
It is no longer acceptable for the council to have a regulatory role without also charging it with the close supervision of such an individual's lifetime professional performance.
The role of the West Pennine Health Authority has been criticised. Health boards in this State which employ GPs as independent service-providers must also look at their procedures for verifying a doctor's past professional performance.
The conviction of Shipman coincides with a vigorous debate within the profession itself on the issue of re-accreditation. Rather than giving doctors the licence to practise for life, the concept of revalidation is now accepted by the majority of doctors.
The details and format of such a process have yet to be finalised. This case underlines the need for a re-accreditation process to be put in place sooner rather than later.
Even the most basic examination of Shipman's practice would have highlighted two things: first, the crude death rate in his practice was many times the national norm (to their credit, a neighbouring practice brought this trend to the attention of the local coroner); second, an analysis of his prescribing habits and patterns would have highlighted the large number of scripts for diamorphine and other opiate drugs with which Shipman dispatched his victims.
It has been suggested that single-handed general practitioners are especially vulnerable in the light of Shipman's misconduct. While such individuals are professionally isolated, they are supported by schemes of continuing medical education, which include an element of peer review.
To tar the GPs of this State who do not belong to a group practice with the crimes of a cold-blooded killer in Britain would be both unfair and unjust.
However, it does seem reasonable that doctors undergoing professional rehabilitation should not work in single-handed practice.
The role of the coroner and the police as a further safety net has also been highlighted. No matter how effective they might have been in this case, they could at best have minimised rather than prevented Shipman's criminal actions.
The extraordinary actions of the GP from Hyde have highlighted a broad range of issues concerning the accountability of the medical profession: doctors must embrace the concept of re-accreditation; health authorities and coroners must re-examine their monitoring role; the public must ask whether the medical profession should continue to regulate itself.
Sadly, following the Shipman case, the cliche "Trust me, I'm a doctor" will for ever have a hollow ring.
