The latest report from the Shipman Inquiry has made a series of hard-hitting criticisms of the General Medical Council structure and culture.
The GMC comes under fire in the report
Dame Janet Smith, the chair of the Inquiry, said the GMC focussed too much on the interests of its members, rather than safeguarding the interests of patients.
Former GP Harold Shipman was convicted of killing 15 patients in 2000. He is believed to have killed at least 200 more.
What did the report look at?
This report, the fifth to be published by the Inquiry into the events surrounding the case of Harold Shipman, focused on how the systems and organisations in place to monitor the work of doctors operated at the time - and what lessons could be learnt for the future.
It looked mainly at the role of the GMC, the body which regulates the medical profession.
But it also examined how the NHS should deal with problem doctors.
Could the GMC have done more to stop Shipman?
Dame Janet and her team looked at events surrounding Shipman's conviction for dishonestly obtaining pethidine in 1976.
At the time, the GMC sent the GP a warning letter and allowed him to return to unsupervised practice. It did not discipline him or place any restrictions on the way he worked.
Dame Janet concluded this was in line with the way in which all such cases were dealt with at that time.
She added that, even if the GMC had issued a harsher punishment, it would have been unlikely to have prevented Shipman from becoming a serial killer.
Dame Janet also cleared the GMC of failure in the way it handled a number of complaints about Shipman, all unrelated to the patients he murdered.
What did the report say about the way in which the GMC operates now?
Dame Janet acknowledges that the GMC is in the process of reform.
It has introduced a speeded-up complaints process and there is a larger contingent of non-medical people on its governing committee - 14 out of 35 are lay members.
But Dame Janet says she does not believe the reforms go far enough, and that they will still not offer patients adequate protection.
She also criticises the culture of the organisation, and says it focuses too much on the interests of doctors, rather than patients.
What changes does the report recommend?
It calls for a basic change of culture, so that the GMC puts patients first.
To achieve this, Dame Janet said the organisation's constitution should be changed so the GMC is no longer dominated by elected members.
She said it should also be directly accountable to Parliament.
The GMC's role in both investigating and punishing doctors, its fitness to
practice procedures, should be split up, the report said.
Doctors should instead be disciplined by an independent body.
Dame Janet recommended this arrangement be assessed within three to four years. with the potential for that role to be taken away from the GMC altogether if it was found to be wanting.
What other recommendations does the report make?
Dame Janet also looked at the role of the NHS in ensuring patient safety.
She examined how Tameside primary care bodies handled Shipman's recruitment in 1977, and whether they or the GPs at the practice which recruited him should have had concerns about the GP. Again, they were cleared.
Looking at present arrangements in the NHS, Dame Janet recommended a number of changes.
She called for a database to be established containing information about all doctors in the NHS, including disciplinary records, which both patients and NHS bodies could access.
Dame Janet also said plans for a new system of revalidation - which will involve regularly checking doctors competency to practise - which are currently being finalised, were not tough enough.
It is proposed that doctors present documentation showing how they have attempted to maintain a high quality of practise.
But Dame Janet said the lack of objective tests of doctors' efforts meant the revalidation procedure would not be able to fulfil its role evaluating a medic's fitness to practise.
There had also been concerns that Shipman evaded detection for so long because he worked alone.
But the report said single-handed practices should be supported and encouraged.
What happens now?
The Health Secretary John Reid will consider Dame Janet's report and decide whether or not to implement her recommendations.