Now Gosport: what next?
Lucy Pocock, Karen Forbes, Colette Reid and Sarah Purdy,
Last month saw the long-awaited publication of the independent inquiry into deaths at Gosport War Memorial Hospital between 1989 and 2000. The inquiry panel, led by The Right Reverend James Jones KBE, concluded that ‘the lives of over 450 people were shortened as a direct result of the pattern of prescribing and administering opioids’. THE SHIPMAN LEGACY Following Harold Shipman’s conviction for murder in 2000, and the publication of the Shipman inquiry, concerns were raised about the regulation of GPs in the UK, particularly in relation to opioid prescribing. Not surprisingly, there is evidence that the case had impacted upon the prescribing practices of doctors, particularly when treating non-cancer patients at the end of life. In 2005, shortly after Shipman committed suicide in prison, a small survey of UK doctors found that nearly half of the respondents (46%) had new uncertainty about prescribing opioids and sedation for terminally ill patients, and 17% of GPs stated that their practice had changed substantially due to concerns about facing a charge of unlawful killing.2 More recently, a qualitative study looking at dyspnoea management in advanced chronic obstructive pulmonary disease (COPD) suggested that the Shipman case had exposed clinicians’ implicit beliefs regarding opioid prescribing, most worryingly the unfounded idea that they might cause a patient’s death directly by prescribing opioids, appropriately, in a palliative care context.3 Gardiner et al found that GPs lacking confidence or expertise in opioid prescribing required significant input from specialist palliative care teams, with some GPs describing how they often simply ‘handed over’ pain control at the end of life to their specialist colleagues.4