TEN years after serial killer Harold Shipman was charged with murder, many of the 200 recommendations made to safeguard the public have still not been brought in, it has emerged.

The Hyde GP is thought to have murdered more than 250 of his patients and was convicted of killing 15 of them. He killed himself in Wakefield prison in 2004.

The case prompted serious concerns about how he was left free to kill for so long and more than £20m of taxpayers’ money was spent on the Shipman Inquiry.

The inquiry, chaired by Dame Janet Smith, looked into his crimes, his background and the system of recording deaths. Six reports — the last of which was published more than three years ago — contained about 200 recommendations, but it has emerged many of the safeguards have not been put in place.

They include a massive shake up of the coroners’ service — Dame Janet recommended it should oversee all deaths and coroners should be medically trained. She wanted investigators to carry out random checks on deaths to make sure the system is working properly. None of these changes have been made.

Dame Janet also wanted deaths certified by the medic who pronounced life extinct and the deceased’s GP, with the facts checked with the family. Each case would be reviewed independently before deciding which deaths need further inquiry. Again, these changes have not been made.

She also recommended doctors’ competency should be regularly assessed. Proposals have been announced for checks every five years, but no start date has been fixed.

Finally, Dame Janet called for better scrutiny of prescribing controlled drugs like the morphine Shipman used to kill his patients. A report from the government watchdog the Healthcare Commission says more work is needed on this area.

John Pollard, Tameside’s coroner who called in police when concerns about Shipman were raised and presided over inquests into the victims, said: "There have been a number of voluntary changes I have made, but to make real change we await legislation. Proposals are expected to be in the Queen’s Speech this year, but they were expected last year and the year before that."

Ann Alexander, the solicitor for the victims’ families, said: "Ordinary people know of the horror around Shipman the individual, but do not understand the ramifications, the loopholes in the system which enabled him to get away with it."

Doctors in the Hyde area have made some changes voluntarily. When someone dies the second doctor to sign the cremation certificate speaks to a member of the family and goes through the medical records. The General Medical Council has started to make some changes, but a spokesman refused to discuss them.

A Department of Health spokesman said: "In February 2007 the government published Learning from Tragedy, a summary of all the action being undertaken in response to the Shipman inquiry.

"This makes clear that the government is implementing a large proportion of the inquiry’s recommendations or, in some cases, taking equivalent action to protect patients and the public."