Harold Shipman's murder of at least 215 patients is the biggest betrayal of trust in history, an official inquiry has concluded.

A report by High Court judge Dame Janet Smith found the former GP could have killed as many as 260 patients.

Shipman was convicted in January 2000 of killing 15 of his patients with lethal heroin injections.

He betrayed their trust in a way and to an extent I believe is unparalleled in history Dame Janet Smith

But Friday's report revealed a further 200 deaths were "highly suspicious". It also stated there was a "real suspicion" he murdered another 45 people.

The finding confirms 56-year-old Shipman as Britain's worst serial killer.

Dame Janet said: "He betrayed their trust in a way and to an extent I believe is unparalleled in history."

She said Shipman had caused "unimaginable distress and grief" and suggested he was addicted to murder.

Church bells rang 215 times in Hyde, greater Manchester, on Friday morning in memory of the victims.

Of Shipman's 215 victims, 171 were women and 44 were men, with the oldest being a 93-year-old woman and the youngest a 47-year-old man.

Five of these people lived on the same street. Nine lived in the same sheltered housing complex.

According to the 2,000-page report, Shipman's first victim was Eva Lyons, killed the day before her 71st birthday in March 1975.

He had been working at the Abraham Ormerod Medical Practice in Todmorden at the time.

Another 71 patients were killed during when Shipman moved to the Donneybrook House group practice in Hyde.

The remaining 143 were murdered after 1992 when Shipman became a solo GP, working on Market Street in Hyde.

Relatives informed

The relatives of the victims have been informed of the inquiry's conclusions.

The findings are based on police and medical records as well as relatives' testimony.

Dame Janet offered her sympathies to the relatives

Shipman's wife Primrose refused to comment on the findings from her home near Wetherby in Yorkshire.

But Dame Janet said the report sets "out as complete and accurate an account of Shipman's criminality as I believe it will be ever be possible for anyone other than Shipman himself to give".

She added: "The way in which Shipman could kill, face the relatives and walk away unsuspected would have been dismissed as fanciful if it had been described in a work of fiction."

Shipman has already been told by Home Secretary David Blunkett he will die in prison. He will also be sent a copy of the report.

The Director of Public Prosecutions decided last year that Shipman would not stand trial again.

If I could get my hands on that man I would. I'm not a violent person but I'd certainly kill him Marjorie Stafford, daughter of victim

The report marks of the end of the first phase of the inquiry which examined the deaths of some 888 patients.

The second phase will now look at how Shipman went undetected for so long and what changes should be made to ensure it can never happen again.

'Highly regarded'

Shipman ran a one-man GP practice in the Manchester suburb of Hyde. He was well-respected and highly regarded by his patients.

He had previously been sacked from a job at another practice after being fined for making out drug prescriptions to feed an addiction to the morphine-like drug pethidine. The General Medical Council disciplined him, but failed to strike him off.

Ann Alexander, solicitor for some of the families, said the report would provide an opportunity for people to come to terms with Shipman's crimes.

"There are thousands of people who have been affected by what has gone on," she told the BBC.

Mr Postle hoped the report would bring closure

She added that she would not rule out seeking compensation for the families involved.

Detective Chief Superintendent Bernard Postles, who led the murder investigation, said: "I hope [the] findings bring some feeling of 'closure' to the friends and families of the dead."

Chris Bird, the son of one of Shipman's victims, said: "My mum had total faith in [Shipman] and that's the most upsetting thing."

Marjorie Stafford, who found out this week that her mother had been murdered by Shipman, said: "If I could get my hands on that man I would. I'm not a violent person but I'd certainly kill him."

Britain's most prolific murderers include Thomas Hamilton, who gunned down 16 children and their teacher at a school in Dunblane, Scotland, in 1996, and "House of Horrors" killer Fred West, who killed 12 young women in Gloucester.

Harold Shipman: Measuring Evil is on Friday at 10:35 BST on BBC One.