University of Leicester eBulletin

Monitoring deaths in general practice would help maintain public trust

January 2003
British Medical Journal media release

Monitoring mortality rates in general practice after Shipman,
British Medical Journal, Volume 326, pp 274-6

Harold Shipman's murderous career led to demands that steps be taken to prevent any recurrence, but devising an acceptable and workable method of monitoring death rates in individual general practices is not straightforward. In this week's British Medical Journal, researchers discuss the key issues in designing such a monitoring system.

Except for a few local schemes, monitoring systems are not yet established, report the authors. They suggest that procedures for investigating abnormal patterns need to be agreed, and that a monitoring system could detect high death rates by using valid comparative data.

Monitoring should also be practical, and not be unduly complex or costly to
administer. A monitoring system must be:

Provide meaningful data for both general practitioners and public health physicians,
Require a minimum of expertise and resources to maintain,
Be acceptable to practitioners and patients.

They admit that there will still be limitations. For instance, monitoring subgroups of GPs, such as locums, assistants and those caring for people in hospices would be difficult, and in practices where individual patients are treated by more than one doctor, analysis would have to be by practice rather than by doctor.

"Monitoring mortality rates among general practitioners' patients would help maintain public trust," they say. "Better information about mortality rates in general practice could also facilitate the planning and monitoring of clinical policies to gradually reduce mortality."

Professor Richard Baker, Clinical Governance and Research Development Unit, Department of General Practice and Primary Care, University of Leicester, Leicester General Hospital, Leicester 

David R Jones, Professor of Medical Statistics, Department of Epidemiology and Public Health, University of Leicester

Peter Goldblatt, Chief Medical Statistician, Office for National Statistics, London

Professor Richard Baker, Department of General Practice and Primary Care,
University of Leicester, Leicester General Hospital, Leicester, UK, telephone +44 (0)116 258 4873, email

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