Dr. Ahmed Salamat




HAROLD Shipman was a General Practitioner near Manchester who committed multiple murders of his patients.


He was convicted on 31 January 2000 and he was sentenced to life imprisonment. Next day, on the 1st February 2000, the Secretary of State for Health announced that an independent public inquiry would take place to establish what changes to current systems should be made in order to safeguard patients in the future. The objectives of the inquiry were:
a. To consider the extent of Harold Shipman's unlawful activities.
b. To enquire into the actions of the statutory bodies, authorities, and responsible individuals concerned in the procedures and investigations which followed the deaths of those of Harold Shipman's patients who died in unlawful or suspicious circumstances.
c. To enquire into the performance of the functions of those statutory bodies, authorities, and individuals with responsibility for monitoring primary care provision.
d. To recommend what steps, if any, should be taken to protect patients in future, and to report its findings to the Secretary of State for the Home Department and to the Secretary of State for Health. Between2002-2005, the inquiry produced 6 reports.
All doctors operate in an environment of trust. What makes Shipman’ case unique is that he exploited and abused his patients’ trust. Patients trust their doctors to apply up-to-date and effective technical skills to their problems. They trust them to care for them, medically and emotionally. Above all, they trust them to place their interests first and to advocate for them. If a patient cannot trust their doctor not to deliberately harm them then how can they trust him not to avoid accidental harm? Or covertly to deny them access to effective treatment?
As a result of Shipman’s inquiry, the medical profession in UK has seen the most radical change in several decades to ensure and guarantee the patient safety. The GMC register doctors to practise in the UK and have the powers to either issue a warning to a doctor, remove the doctor from the register, suspend or place conditions on a doctor's registration. It has also a statutory role to provide guidance to doctors and to undergraduate medical students on medical ethics. The Good Medical Practice issued in 2006 sets out the principles and values on which good practice is founded (see table).

In November 2009 the GMC introduced the licence to practice. Licensing is the first practical step towards the introduction of a new system called revalidation. To practise medicine now in UK all doctors are required by law to hold both registration and a licence to practise.
The revalidation system will require doctors to renew their licence to practise periodically. The purpose of revalidation is to give patients regular assurance that doctors registered with a licence are up to date and fit to practise.

I was stimulated to write the above introduction by a sad story that was posted on Ibnosina website recently. The story was posted by Dr. Kurer. It was a story of a young pregnant female who had a complicated management course of her delivery with presence of liver dysfunction (HELLP Syndrome?). I felt that her care was not optimum and we should pause and think about such cases. Most patients enter hospital with the belief that they will be treated by competent staff, and that they will receive whatever treatment they need in order to achieve a successful outcome. This is their right and should be protected by the law and be enshrined by the medical profession.

Although most Libyan doctors are caring decent people, there is an anecdotal evidence to suggest that many do work beyond their level of competence and free from any accountability. So such tragic story is possible and could be repeated again. I do see an urgent need to reform the healthcare system to not neglect such very serious issue.


GMC-Principles of Good Medical practice
 Make the care of your patient your first concern
 Provide a good standard of care
 Keep your professional knowledge and skills up to date
 Work within the limits of your competence
 Treat patients as individuals and respect their dignity
 Work in partnership with patients
 Listen to patients and respond to their concerns and preferences
 Give patients the information they want or need in a way they can understand
 Respect patients' right to reach decisions with you about their treatment and care
 Be honest and open and act with integrity
 Act without delay if you have good reason to believe that you or a colleague may be putting patients at risk
 Never abuse your patients' trust in you or the public's trust in the profession.
 Must always be prepared to justify your decisions and actions.
 You must act if you have good reason to think that patient safety is or may be seriously compromised.



Dr Ahmed Salamat (MRCP, FRC Path)
Consultant Haematologist
Swansea UK