The conviction of Dr Harold Shipman for murdering 15 of his elderly female patients could lead to tighter restrictions on the handling of Controlled Drugs and pressure on self-regulation by the professions.
A wide-ranging independent inquiry announced by the Secretary of State for Health (Mr Alan Milburn) on February 1 is to include an investigation into how Dr Shipman was able to stockpile large quantities of diamorphine. Mr Milburn has also announced that in future GPs will be required to disclose criminal convictions and report deaths in their surgeries.
Dr Shipman, who had a single-handed practice at 21 Market Street, Hyde, Greater Manchester, was convicted on the 15 murder charges at Preston crown court on January 31. He had killed the women by injecting them with lethal doses of diamorphine. The Crown Prosecution Service is currently deciding whether to charge him with a further 23 murders.
It was disclosed after the verdict that Dr Shipman is a former drug abuser. He was convicted of drug offences involving pethidine in 1976, having forged prescriptions in order to feed his addiction. The General Medical Council took no action against him but, because of his history, he agreed not to hold stocks of CDs at his surgery. Nevertheless, he appears to have accumulated large quantities of diamorphine by prescribing it for patients and collecting the dispensed medicines himself or by recovering unused medicines after a patient's death.
One possible outcome of the Shipman inquiry is that doctors may be banned from collecting CD prescriptions from pharmacies on behalf of their patients. Such a ban has been suggested by West Pennine health authority in a confidential report sent to the Department of Health in April, 1999, following an investigation precipitated by the arrest of Dr Shipman. The report, which was released to the press after Dr Shipman's conviction, recommends that pharmacists should not be able to dispense CDs to doctors acting as their patients' agents and that doctors should not receive CDs from the relatives of deceased patients.
A health authority spokeswoman told The Journal on February 1: "The real challenge is finding a system that is workable and not so bureaucratic that it makes it difficult for everybody. As the National Health Service, we need to be able to say that we are doing everything we can to protect patients and doctors."
She said that although Dr Shipman was now considered to have been overprescribing morphine, it had not been obvious at the time. He had been the health authority's highest overall prescriber. He had prescribed large quantities of very expensive medicines and had refused to use generics at all. He had also been its sixth highest prescriber of morphine, but had not seemed to prescribe significantly more than anyone else.
Another West Pennine recommendation that the inquiry will consider is that all death certificates should be signed by a second doctor after a check of the patient's medical record. If not satisfied that the certified cause of death was related to previous medical history, the second doctor would ensure that the death was referred to the coroner. Also for review in the inquiry are the issuing of cremation certificates, the monitoring of death rates and the regulation of single-doctor practices. The inquiry will also focus on the workings of the GMC and its practice of having doctors investigate doctors.
Commenting on the manner in which Dr Shipman obtained his illicit supplies of Controlled Drugs, Mr Stephen Lutener (head, pharmacy law, Professional Standards Directorate, Royal Pharmaceutical Society) told The Journal: "Any suggestion that regulations should be amended is a matter for the Home Office. The Society would want to be party to any discussions."
Mr Lutener said that he could not see an easy solution that would prevent devious individuals from obtaining CDs without also jeopardising patient care. "We would not wish to stand in the way of doctors obtaining drugs for the proper treatment of their patients, but we are considering if there are any measures we can usefully propose," he said.
The Journal understands that the Society is satisfied that a pharmacy next door to Dr Shipman's surgery had not behaved inappropriately in supplying CDs. The Society's inspector for the area had been in contact with the police from the early stages of the investigation. There was nothing that would raise concerns to him about the pharmacy's supplies.