Harold Shipman's Clinical Practice, 1974-1998 A Review Commissioned by the Chief Medical Officer

This audit of the clinical practice of Harold Shipman was commissioned by the Chief Medical Officer for England following the conviction of Dr Shipman for the murder of 15 of his patients. The aims of the audit were to identify: the pattern of observed deaths in particular age groups; deaths showing unusual clusters in time; deaths showing unusual clusters by place of death; the relationship between certified cause of death and medical history; the integrity of records; the prescribing of restricted drugs. The sources of information used were: the medical certificates of cause of death (MCCDs) issued by Shipman and those issued by a comparison group of local general practitioners; surviving clinical records and cremation forms; data provided by the Prescription Pricing Authority and controlled drugs registers at pharmacies in the area where Shipman worked. This clinical audit reveals clear evidence of a higher level of deaths than would have been expected over a long time period. The excess of deaths does not appear to be explicable on grounds that his practices served populations with markedly different demographic or health profiles. Typical features relating to the deaths are: a high proportion of deaths among older women; a high proportion of deaths occurring at home; a high proportion of deaths occurring in the afternoon; Shipman was present at the death or had seen the patient shortly before death in a high number of cases; a high proportion of patients were certified as having died from heart problems, strokes or old age; the association between clinical history and certified cause of death was often weak. A number of recommendations are made on issues such as monitoring performance in general practice, monitoring death rates, death certification procedures, general practice records, controlled drugs and the review of care of individual patients. The report author emphasises that the recommendations are personal and rest on limited sources as evidence and should be regarded as starting points for discussion on steps that could be taken to prevent doctors such as Shipman murdering patients in the future.