Doctors' leaders have called for an immediate inquiry into all the circumstances surrounding the case of Harold Shipman.

British Medical Association chairman Dr Ian Bogle said he was horrified at the details of the case.

He said: "It is important that the government and the medical profession move quickly to reassure the public about the high quality of care delivered by the vast majority of doctors in this country.

"It is also important to differentiate the issues surrounding the evil criminal acts of a murderer who happens to be a doctor from the protection of patients from underperforming doctors."

Dr Bogle said the BMA would like to see:

• A better definition of the categories of death which the coroner is required to investigate
• A statutory obligation on doctors to notify such deaths directly to the coroner
• A similar statutory obligation on nurses, undertakers and others involved in the disposal of the dead to notify any concerns to the coroner
• Changes to the system for registering deaths and recording cremations, which would allow better collection of data and monitoring of events that may cause concern
• Larger regional coroners' offices, controlled by coroners qualified in both medicine and law
• Improvements in education on forensic medicine at undergraduate and post graduate level for all doctors

The NHS Alliance, which represents primary care groups, the GP-led organisations responsible for deciding the shape of NHS services locally, said the Shipman case had "sent doctors reeling just as much as their patients".

It issued a statement saying that doctors and patients had to work together to ensure a similar case could never happen again.

Alliance chair Dr Michael Dixon said: "The old days of so-called 'total clinical freedom' are over.� And good riddance too.

"From now on, doctors must be able to justify their clinical decisions.

"Harold Shipman was a one-off.� We have never seen anything like him before.� That is why his killing went undetected for so long.

"Patients are right to have confidence in their family doctors.� But that does not mean that any of us should pretend this case never happened.

"Changes in the way GPs practice - some already implemented and some planned - will go a long way to make sure there are no future Shipmans."

The alliance said primary care groups had created a new system under which GPs worked much more closely together so that single-handed doctors like Dr Shipman would not be professionally isolated.

In addition, a new system putting the onus on GPs to ensure a high quality service should root out under-performers at an early stage.

However, the alliance called for GPs to be compelled to publish comprehensive information about rates of illness and death, and the outcomes of treatment.

It also called for whistleblowers to be able to report concerns without fear of retribution.

NHS managers

The NHS Confederation, which represents health authorities, said the Shipman case was about the shortcomings of an individual doctor, but said it also highlighted areas that have needed reform for some time.

In a statement, the confederation said a range of measures had already been put in place to significantly improve the way general practice is run.

These include:

• Proposals from the General Medical Council and the Royal College of General Practitioners for doctors to have to prove periodically that they are fit to practice
• Measures to improve record keeping in general practice
• A new onus on doctors to audit the quality of their work
• National guidance on improving and dealing with poor performance in general practice

Nigel Edwards, NHS Confederation policy director said: "We would support Government in addressing the specific issues about performance management in primary care and ensuring that any additional lessons are incorporated into the large amount of policy that has already been issued.

"The NHS Confederation would wish the Home Office to respond in a similar way to this case that the Department of Health have to the areas that fall under their control. In particular the HM Coroner system is in desperate need of modernisation."