Doctors are too focused on "looking after their own" according to a "bruising" report into the case of serial killer Dr Harold Shipman published today.

Doctors are too focused on "looking after their own" according to a "bruising" report into the case of serial killer Dr Harold Shipman published today.

The watchdog in charge of regulating GPs, the General Medical Council, is heavily criticised for its procedures and its culture and has "fundamental" flaws, the report states.

The GMC sides too easily with its own profession and has failed to protect patients from rogue doctors.

And despite changes brought in by the GMC to get its own house in order, its culture has not changed enough to properly protect the public.

The 1,300 page report by Dame Janet Smith, a High Court judge in charge of the Shipman Inquiry, lists more than 100 recommendations for change.

"Having examined the evidence, I have been driven to the conclusion that the GMC has not, in the past, succeeded in its primary purpose of protecting patients," Dame Janet said.

"Instead it has, to a very significant degree, acted in the interests of doctors."

Dame Janet said the culture within the medical profession led to an imbalance of being fair to doctors ahead of protecting patients.

And she said she did not "feel confident" the GMC will change in the "right direction".

She also criticised the GMC for not going far enough in its reforms since Shipman and being too "reactive" - only acting after medical scandals come to light.

"I am by no means convinced that the new GMC procedures will adequately protect patients from dysfunctional or under-performing doctors," the report states.

"I have concluded there has has not yet been the change of culture within the GMC that will ensure that patient protection is given the priority it deserves."

Mass killer Shipman, who worked at a one-man practice in Hyde, Greater Manchester, murdered at least 215 patients by lethal morphine injections.

He was allowed to carry on practising by the GMC despite being convicted of drug offences in 1976 after becoming addicted to pethidine as a young doctor.

Although he had a very high death rate among his patients, other doctors did not raise concerns to stop his 23-year killing spree.

The report only just stops short of recommending the abolition of the GMC and does not say the watchdog allowed Shipman to "get away with it".

Dame Janet said: "It seems to me that one of the fundamental problems for the GMC is the perception, shared by many doctors, that it is supposed to be 'representing' them. It is not - it is regulating them."

She goes on to say her criticism in the report is likely to be "bruising" for the GMC.

Shipman, 57, was jailed for life after being convicted of 15 counts of murder at Preston Crown Court in January 2000.

He was found hanged in his cell in Wakefield Prison in January this year.

This is the fifth report following the Shipman Inquiry, started by the Government in the aftermath of the doctor's killing spree, to try to protect patients in future.

Today's report, titled Safeguarding Patients: Lessons from the Past - Proposals for the Future, will be sent to the Department of Health to consider its recommendations.

Dame Janet called for the medical profession to lose its majority on the GMC in her recommendations at the end of the report.

She said the number of lay members of the GMC should be increased.

The report said: "The GMC's constitution should be reconsidered, with a view to changing its balance, so that elected medical members do not have an overall majority."

It added: "The GMC should be directly accountable to Parliament."

Dame Janet also said the GMC should introduce "a periodic evaluation of every doctor's fitness to practise".

"Revalidation could make a major contribution to the identification of incompetent and poorly performing doctors and thus to patient safety," she said.

"Unfortunately, the present proposals for the revalidation of GPs do not provide an evaluation of fitness to practise and cannot achieve this important objective."

While the GMC came in for the bulk of the criticism, Dame Janet made a number of recommendations to the NHS.

The most significant were proposals to increase the amount of information about doctors available to employers and the public.

The report said: "There should be a central database containing information about every doctor working in the UK."

Dame Janet recommended that the database, which would contain disciplinary records among other information, should be accessible to bodies such as the NHS, GMC and Department of Health.

It also said procedures should be put in place to make it easier for staff to raise concerns.

"Staff should be encouraged to bring forward any concerns they may have openly, routinely and without fear of criticism," it said.

The report recommended that patients should have access to information such as a doctor's current registration status and past fitness to practise.

It said: "In all cases where a GP's registration is subject to conditions, or where he/she has resumed practice after a period of suspension or erasure, patients of any practice in which the GP works should be told.

"Patients should have the opportunity to refuse to be treated by a doctor who is subject to conditions or who has previously been subject to an order for suspension or erasure."

Responding to the latest Shipman report, the Health Secretary John Reid said he wanted to reiterate the Government's sympathy to the relatives and friends of victims.

"The scale of these crimes was unprecedented and his activities were totally abhorrent.

"We need to learn lessons from the mistakes of the past to help safeguard patients in the future," Dr Reid said.

"We have been working hard with the medical profession and others to strengthen the systems, rules and regulations that govern the medical profession.

"Standards of behaviour must be high and action against those who fail to maintain those standards must be timely, firm and fair."

Dr Reid thanked Dame Janet and her team and said they would consider the detail of the report's recommendations before responding properly next year.