The senior judge behind the Shipman inquiry has said she is "disappointed" that key recommendations from her report have not been achieved.
Dame Janet Smith was in charge of an investigation into Harold Shipman, Britain's most prolific serial killer, who murdered 215 of his patients using the drug Diamorphine over a period of 20 years.
She recommended changes to the structure of the General Medical Council (GMC), tighter access to controlled drugs and reform of death certification to make it less open to abuse.
But Dame Janet told BBC One's Inside Out North West that not enough changes have been made since her inquiry.
She said: "We haven't moved at all on the basic death certification. It's exactly the same.
"There hasn't been any further work done since I moved off it in 2003."
More stringent cremation forms were introduced in January last year but there is still no unified system covering all deaths, as Dame Janet recommended.
Revalidation, an 'MOT' of a doctor's fitness to practice, also hasn't been introduced.
Barry Swan, whose aunt and mother were both killed by Shipman, told the programme: "It would be a travesty after all that we have been through if there were still loopholes."
But GMC chief executive Niall Dickson said progress has been slow because doctors feel threatened by change.
He said: "Part of the reason is convincing the profession that it is a good idea - and I think that we have begun to do that. But I think it has been a slow process.
"And I certainly think some older doctors found it a threatening process."
In a statement to the programme, the Department of Health said the majority of recommendations from the Shipman Inquiry have now been implemented.
A spokesman said: "This, crucially, included much better safeguarding of controlled drugs.
"Reforming the process of death certification requires changes to primary and secondary legislation - this takes time.
"We've already made changes to primary legislation and decisions on priorities for this area will be made in the coming weeks."
The programme also analyses letters written by Shipman from prison that have never been seen in public.
In one he says: "No-one saw me do anything. As for stealing morphine off the terminally ill again no-one saw me do it."
BBC Inside Out North West: Shipman - When Doctors Kill on BBC One, Monday, July 19 at 7.30pm.Reuse content