Britain's doctors are still imbued with a club culture that puts their interests before the patient, a damning report into the activities of the serial killer Harold Shipman declared yesterday.

The watchdog that is supposed to regulate doctors was accused of operating a closed shop for the mutual protection of colleagues instead of acting to protect the public.

The inquiry into the crimes committed by Shipman, a Manchester GP who murdered at least 215 patients, concluded that there were fundamental flaws in the General Medical Council (GMC), which was heavily criticised for failing to protect patients from rogue doctors. Although it was cleared of blame for the deaths of Shipman's victims, because no one gave it the information that might have led to the discovery of his crimes, the GMC was still too focused on being "looking after its own", the report said.

In a clinical dissection of its failings, the High Court judge Dame Janet Smith, who chaired the inquiry, said despite efforts to change, the organisation remained too reactive, with a culture described as something between an old boys' club and a trade union for medics.

"The old culture of protecting the interests of doctors lingers on for the majority of GMC members," Dame Janet said. "A significant change of culture is necessary ... However, I do not feel confident that it will do so."

The 1,300-page report lists more than 100 recommendations for change of which more than half are targeted at the GMC. It is the fifth report from the inquiry into the GP serial killer, jailed in 2000, which was set up by the Government to try to protect patients in the future.

It only just stops short of recommending the abolition of the GMC, but says its investigatory and judicial functions must be separated, with an independent body set up to hear disciplinary cases.

It should have a majority of lay members, up from the current 40 per cent, and there should be more lay members on its disciplinary committees. The GMC should also be accountable to Parliament, the report said. Dame Janet implied that the GMC was living on borrowed time, recommending an independent review of its fitness-to-practice regime within three to four years.

"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."

The GMC said it had put in place the biggest reform programme in its 150-year history, with big changes to the way it investigates and disciplines doctors brought in last month, and new five-year checks on doctors to come in next April.

But Dame Janet said the reforms did not go far enough. "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 not yet been the change of culture within the GMC that will ensure that patient protection is given the priority it deserves."

Shipman, who worked at a one-man practice in Hyde, Greater Manchester, murdered 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.

Dame Janet said: "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 praised proposals for regular checks on doctors' performance - the five-yearly "MoT for medics" known as revalidation - but said the GMC had been "in retreat" since they were put forward and they were now so watered down they would not be effective. The report said there should be a whistleblowing hotline so members of the public can raise concerns about doctors.

Dame Janet said the "prevalent" attitude among doctors was that "it was not done" to question and report a fellow doctor to the GMC. "The culture of unwillingness to report doctors is still there," she said. "It must go. There can be no room today for protection of colleagues when the safety and welfare of patients are at stake."

The reportSafeguarding Patients: Lessons from the Past - Proposals for the Future will be sent to the Department of Health.


* Investigation and judicial functions of GMC to be separated

* New independent tribunal to be set up to adjudicate on disciplinary cases

* More lay members on the GMC so doctors no longer have majority

* More lay members on disciplinary panels

* GMC to be accountable to Parliament

* Five yearly "MoT" checks of a doctor's performance, called revalidation, to be strengthened

* Telephone helpline for whistleblowers so the public can raise concerns about a doctor

* Strengthened arrangements for complaints handling and investigation by GP practices

* Central database of information for the public on doctors

* Improved monitoring of prescribed drugs

* Department of Health to set up a system for monitoring GPs' death rates