Introduction

The fifth report of the Shipman inquiry provided a thorough and considered analysis of the issues surrounding fitness to practise.1 We must all approach the report in the spirit of learning from the past and as a source of ideas for improving the protection of patients in the future. The government's proposals to improve death certification and for tighter regulation of controlled drugs2 will, alongside clinical governance, help stop another Harold Shipman. Nevertheless, the General Medical Council recognises that further changes are required to our processes.

How can we ensure new doctors remain fit to practise?

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Lessons from the inquiry

Some have argued that no general lessons can be drawn from the Shipman case. I believe that view is mistaken. Of course many of the circumstances were specific, but much broader, historical issues were raised. These include:

• The absence of local systems that could detect emerging poor, dangerous, or criminal practice and take effective action at an early stage before patients came to harm

• Uncertainty among patients about how to pursue a concern about a doctor, together with a profound feeling of disempowerment

• Reluctance by some professionals to admit even the possibility that a doctor might be putting patients seriously at risk

• Lack of coherence and coordination between the roles of the NHS and the GMC in protecting patients

• And the lack of robust and systematic arrangements to verify that doctors are up to date and fit to practise.

Dame Janet Smith, the chairman of the inquiry, acknowledged that much has changed for the better, but we all have more to do, whether within our regulatory bodies, healthcare organisations, or clinical teams or as individual healthcare professionals. We need to ensure that further …