3 May 2008

System for monitoring doctors

A system of monitoring doctors to try and detect or deter any future Harold Shipman - which has been recommended for implementation in England - is unlikely to be effective, a study led by the University of Dundee has found.

Researchers found that routine mortality monitoring in general practice was only likely to signal an alarm for a mass murderer like Shipman once they had already completed dozens of killings.

The researchers, led by Professor Bruce Guthrie at the Tayside Centre for General Practice, University of Dundee, looked at the likely effectiveness of routine mortality monitoring, one of the measures recommended by the Shipman Inquiry to increase the chance of deterring and detecting a future Shipman.

The Chief Medical Officer in England has already recommended that the NHS should further develop and pilot `a national system for death monitoring as part of a wider clinical quality assurance framework.’

Running a series of statistical models the researchers found that even an extreme killer like Shipman may only be picked up by the system when they had already killed repeatedly.

"A monitoring system that can only detect a serial killer after 30 or more people have been murdered is not `effective’ in any meaningful way, and represents a failure of other mechanisms intended to detect and deter murderers by ensuring that every death is properly accounted for," said the authors in their report, published in the British Journal of General Practice.

"It is extremely difficult to establish an effective monitoring system like this and there are clear doubts over how effective it can be," said Professor Guthrie.

"Based on our analysis, monitoring mortality rates is not enough and cannot substitute for other recommended reforms, such as an effective reform of the coroner and death certification systems which were also recommended by the Shipman Inquiry but have not been pursued."

The researchers used statistical data from the NHS in Scotland to examine coverage provided by a mortality monitoring system and how successful it would be in detecting murderers.

They found that monitoring practices even over a three-year period was severely limited by the relative instability of the individual doctors who make up practices - in Scotland 40% of practices have at least one GP arrive or leave in that timespan.

Furthermore, all the detection systems they examined generated large numbers of false `alarm’ signals requiring further investigation.

"Monitoring by practice appears not to produce the desired results," said Professor Guthrie. "However, monitoring individual practitioners is not feasible in the UK due to because patients are now registered with practices not individual doctors, and get their care from a team."

"Our study also shows that large numbers of false alarms would be created under the monitoring system, which increases the risk that a rare true alarm would be ignored."

"We would all of course hope never to see another case like Harold Shipman’s, but it is important we have the systems to hopefully detect one if it does occur. By our analysis routine mortality monitoring can not provide that security. Implementing other recommendations of the Shipman Inquiry to make death certification and the coroner system more robust would be a better use of resources to ensure that every individual death is properly accounted for."

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Roddy Isles
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