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Britain's most prolific serial killer is currently serving life imprisonment for the murder of 15 patients by lethal injection.
But a Department of Health analysis, comparing his medical records with those of other GPs, suggests he is likely to have killed a minimum of 236 patients and possibly more than 300.
The residents of Hyde in Greater Manchester, where Shipman practised for more than 25 years, had expected this news.
Jayne Gaskell, whose 68-year-old mother Bertha Moss almost certainly died at the hands of Harold Shipman, said: "We were prepared for this. We knew before the trial ended that there would be around about this total, maybe more."
Shipman, who was arrested in August 1998, was not actually charged with Mrs Moss's murder which makes her death even more difficult for the family to come to terms with.
Professor Richard Baker, of the University of Leicester, who carried out the analysis on behalf of the Department of Health, said a clear pattern had emerged from Shipman's records.
He said: "In all the cases we examined Harold Shipman was likely to have been present at the time of death or have visited the patient recently.
"The patient was more likely to have died suddenly, more likely to have died at home, more likely to have been older and certainly more likely to have been female."
Andrea Robinson, from the Families Support Group, said: "I am shocked but not surprised.
"It's like a dog with a bone, the more you dig the more you are going to find."
The report has been handed to Greater Manchester Police.
But Director of Public Prosecutions, David Calvert-Smith QC, has said further trials could not take place fairly because of the huge amount of media publicity the case has already generated.
Shipman began a life sentence at Frankland Jail, Co Durham, after he was convicted of 15 murders in January 2000.
A raft of new checks and controls on doctors was introduced in the wake of the Shipman murders.
A public inquiry, chaired by Dame Janet Smith, was opened in June 2001. It finally concluded Shipman may have killed as many as 250 patients over 23 years.
The finding confirmed Shipman as Britain's worst serial killer - ahead of Mary Ann Cotton, believed to have poisoned more than 20 people in the 19th century.
According to the report, published in July 2002, his first victim was Eva Lyons, killed the day before her 71st birthday in 1975.
He had eight previous convictions, including one in 1976 for falsifying prescriptions to feed an addiction to pethidine, a morphine-like drug. The General Medical Council disciplined him, but did not strike him off.
In July 2003 after a second phase of the inquiry, Dame Janet criticised Greater Manchester Police for they way they handled the case and said the last three victims might have been saved "if the police and coroner had moved with reasonable expedition".
On 13 January 2004 Shipman died after he was found hanging in his cell at Wakefield prison.
The true extent of his crimes while a trusted family GP in Greater Manchester and West Yorkshire may never be known.
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