‘Last seen before death’: the unrecognised clue in the Shipman case

There have been very few mortality surveys at individual practice level. This lack of robust comparative information is one of the reasons why the full extent of Harold Shipman’s possible murderous activities went unrecognised until Richard Baker undertook his comprehensive study as a part of the official Shipman Inquiry.

This review looks at 752 deaths over 11 years in a single suburban Birmingham practice. In addition to recording the age and sex of the patient, and the place and cause of death, the extra, previously unrecorded, parameter of when the general practitioner last saw the patient alive was included. Only 8% of patients were seen alive on the day of death, in comparison with Dr Shipman actually in attendance at almost 20% of his patients’ deaths.

Although these are only the results of a single practice study, they offer a benchmark for further comparative data collection to define patterns of mortality in the community. They also suggest only minor modifications to the notification of cause of death procedures are needed to identify another Shipman.