Jeremy Laurance: These checks would have stopped the killer GP

I laughed at the report of convicted murderer Brian Lawrence's escape attempt. Locked up in the Isle of Wight's Parkhurst prison, the 67-year-old had plotted to buy a helicopter to spring him from the high security jail by sending notes written in "invisible ink" – lemon juice – to accomplices outside. It was a trick straight out of a 1950s Boy's Own annual. A quick press with a hot iron and, hey presto!, the words emerge in pale brown script. Barry Greenberry, prison governor, paid tribute to the way his team had "diligently pieced together intelligence" to stop the escape. Presumably by reading Enid Blyton.

Ah, the innocence of age. We are all products of our time. I thought of this reading the weekend reports about Howard Martin, the GP struck off the medical register by the General Medical Council (GMC) last week, after it had ruled that he had hastened the deaths of 18 patients in "egregious, despicable and dangerous" conduct. Dr Martin, now 75, protested that he had only acted out of "Christian compassion" by giving large doses of diamorphine to patients, in two cases admitting that he hastened their deaths without their permission. He was a busy doctor with a lot of patients to see and he didn't have time to go through what he implied was the bureaucratic process of obtaining consent.

Reading the reports I was struck by the innocence of his remarks. Martin qualified over half a century ago, in 1958. He spoke as if he was still stuck there, in an age when patients did not expect to make choices, would not have dared question their doctor and accepted that he would do what he thought best.

The world has since moved on, but Martin appears not to have done. He said he was "deemed to be arrogant because I used my discretion". But he failed to acknowledge the need to be accountable for his actions. He just didn't get it.

The most disturbing aspect of the case is how long it has taken to remove him from a position where he might threaten patients. The alarm was first raised in 2000, after complaints from Macmillan cancer nurses led to a police investigation. Then there was the murder trial in 2005 when he was found not guilty of killing three patients.

It is to detect doctors like Howard Martin, who have failed to move with the times – in skills, knowledge or attitudes – that regular checks of their competence are urgently needed. The GMC has been negotiating with the medical profession for more than a decade over introducing such checks – known as revalidation – with little progress. Three weeks ago I wrote about the British Medical Association's decade-long opposition to revalidation. In response, the BMA protested that, in fact, they supported the measure in principle. What they didn't say was that that was their position in 2000, too.

How many more Howard Martins will be left to practise their particular brand of "egregious, despicable and dangerous" medicine before the BMA and GMC settle their differences?