The inquest into the death in prison of the mass murderer Harold Shipman stirred the memory of his terrible crimes last week. But his name will not be mentioned on the hustings and it will seldom crop up in debate even though he should be a central issue in the election campaign.

Repairing flaws in the health service exposed by Shipman’s homicidal practice is as important to the welfare of patients as building hospitals or training consultants. But five years after the GP’s conviction the archaic system of regulation that allowed him to kill 250 people over 26 years remains virtually intact.

Blunders, loopholes, shortcomings and cover-ups were exposed by Dame Janet Smith’s public inquiry and her conclusions pointed clearly to radical changes designed to prevent another doctor from becoming a serial killer. But the cue for political action was missed. Instead of prompt action to translate the unequivocal detail of Dame Janet’s recommendations into legislation, mandarins and politicians took refuge in a “review” of the proposals by Sir Liam Donaldson, the Chief Medical Officer. This makes those of us involved in the Shipman case uneasy for two reasons.

First, Dame Janet reached her conclusions after a wholly independent inquiry that dissected all the circumstances surrounding the killings, from the wards of Pontefract General Infirmary to Shipman’s rounds in Hyde. There has been no greater investigation of patient safety or the governance of medicine, and I am sceptical of any added insight that may be contributed by Sir Liam, who is a doctor.

Doctors worried Dame Janet. She was particularly worried about the apparatus for ensuring that any incompetent doctor is brought quickly to the attention of the General Medical Council (GMC) and dealt with. The apparatus has been discredited as partisan and inadequate. Do little or nothing and patients will suffer, if not from the syringes of a serial killer then at the hands of a calamitous surgeon or slipshod anaesthetist.

But since Shipman was convicted a dangerous misconception has gained ground, even though it was dispelled fluently in Dame Janet’s report. “It is said that Shipman was a killer who just happened to be a doctor,” she said. “I do not agree. It was the very fact that Shipman was a doctor that enabled him to kill and remain undetected.”

Shipman exploited defective systems for certifying deaths and regulating controlled drugs, such as the morphine he used on his victims. He was concealed by shortcomings in the operation of coroners’ courts.

But the main thread running through her report is a compelling list of changes needed if the GMC is to do its job of ensuring that doctors are fit to practise. The GMC fails in its declared purpose of “protecting patients — guiding doctors”. Instead, it subordinates the need to protect patients to fairness for doctors. “For the majority of GMC members, the old culture of protecting the interests of doctors lingers,” Dame Janet said, and she devoted no fewer than ten chapters to describing how that culture survived, despite some “beneficial” changes.

I can add an anecdotal, post-Shipman inquiry footnote. A hospital specialist told me that mistakes had been spotted in a colleague’s work. The doctor was directed by the GMC to retraining at a cottage hospital. Now he is back at work, as incompetent as ever.

Doctors have become accustomed to believing that they deserve privileged treatment. But why, if I have a client who has complained about a doctor, can I not discover whether the doctor has been sued before? A lawyer who makes a mistake must tell the client and report the error. It is a professional duty. A solicitor is at risk of being prosecuted for misconduct for failing to advise a client that he should consult someone else. Not doctors. They can be assured that when they err they will receive a sympathetic hearing — nothing more, perhaps, than retraining at a cottage hospital.

The enduring impression gained by those relatives of Shipman’s victims whom I represented is that the medical profession cannot acknowledge that doctors can be incompetent or irresponsible or in extreme cases can kill patients. That means that all of Dame Janet’s proposals should be embraced. Scrap the whole system.

The GMC is a statutory body and legislation is needed if changes are to be made. It requires political will — and that is the second source of unease.

In July 2000, six months after Shipman’s conviction, the families of his victims emerged from the Royal Courts of Justice with a second legal victory. The judges had quashed the decision of Alan Milburn, then the Health Secretary, to hold the Shipman inquiry behind closed doors.

Milburn’s decision astonished many observers, but not those familiar with medical politics . . . better let the “experts” sort it out in Whitehall’s closeted consulting rooms. And that’s where the Shipman report is now. Seven years after the body of his final victim was exhumed, the lessons are in danger of being buried as Sir Liam ponders patient safety and politicians debate medical politics in the idioms only of targets and budgets.

Dame Janet’s work offered more than a streamlined system of detecting killer doctors. She raised the prospect of enhancing the detection of all forms of “aberrant behaviour or substandard performance in doctors”. Finally she described how “the good quality of care provided by the large majority of doctors should have scope and opportunity for continued improvement”.

What finer election promise could there be?

The author, a solicitor specialising in medical negligence, represented the families of nearly 200 of Harold Shipman’s victims

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