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When Harold Shipman, the trusted family doctor in a village outside Manchester, was arrested in 1998 on suspicion of killing elderly women in his care, such was the shock that handwritten notices from his patients went up in his main street storefront office saying, ''We don't believe it.''

Last January, people watched with a different kind of shock as the bespectacled white-haired physician was convicted of all 15 murders that he had been charged with. Today, the British learned that the real number of people Dr. Shipman had injected with lethal doses of diamorphine in his 24-year career might have been hundreds more.

The trial a year ago chronicled his macabre method. He would unexpectedly visit the chosen patients -- women mostly older than 75 -- in the afternoon, when they were most likely by themselves; administer ''treatment''; and leave. When he returned to find them dead or in response to word that they had died, he would declare the cause as heart attack, stroke, cancer or simple old age and sign forms forgoing post-mortems and arranging prompt cremations.

He was caught only when he deviated awkwardly from that pattern in the one case in which he tried to make money. He tricked one victim, Kathleen Grundy, 81, into making him the sole beneficiary of her $500,000 estate by forging her will. That aroused the suspicions of her children, who insisted on an exhumation, which led to the finding that she had been poisoned.

Today's disclosures emerged in a report commissioned by the Health Department in response to widespread suspicions that the number of victims was considerably higher than those covered in the trial or knowable through formal prosecution. The 145-page report, made public in a news conference here today, is a statistical document, heavy with charts, graphs and numerical tables that meticulously review Dr. Shipman's habits.

Judge Dame Janet Smith of High Court has been named to begin a public inquiry next month into some of these new cases of suspected murder and into how Dr. Shipman could have stockpiled morphine, altered medical records, gained the compliance of fellow doctors and otherwise gone undetected by the profession for so long despite such overwhelming evidence of gross malpractice.

The author of the new report, Prof. Richard Baker, a health academic at Leicester University, compared Dr. Shipman's mortality rates with those of other local general practitioners, four in Todmorden, north of Manchester, where he worked from 1974 to 1975, and six from Hyde, in the eastern suburbs, where he worked from 1977 until his arrest.

It showed that Dr. Shipman had 297 more recorded deaths than the similar practices and that 236 occurred at home, with a remarkably high percentage of the others in his office. It also found that he was 25 times more likely to be present when a patient died than the other doctors, that the proportion of his patients who experienced swift deaths was more than twice that of the other physicians and that there was also more than twice the likelihood that no relatives were present at death.

An extraordinary number of the deaths occurred from 1 p.m. to 6 p.m., and more than half the medical certificates of cause of death he signed were faulty.

Professor Baker said he thought that his study, though circumstantial, was conclusive. Experts behind the study told the Press Association, Britain's domestic news agency, that they were reluctant to put a final figure on the death count, but said it could be as high as 345.

''I feel essentially rage, as a fellow professional, that someone betrayed the trust of people who were completely dependent on him,'' Professor Baker said.

At the end of the trial last year in Preston Crown Court, the police said they had sufficient evidence to try Dr. Shipman for an additional 23 murders. But the Crown Prosecution Service decided against further trials, and none are expected to arise out of the new report.

''He is now serving life, which means the rest of his natural life,'' the director of public prosecutions, David Calvert-Smith, said tonight. ''The possibility of any jury being impaneled now which did not have a firm prejudice against Shipman, having read and heard all they would have heard over the last year or so, means it is impossible really to say that he could have a fair trial.''

Dr. Shipman, 54, is serving 15 life terms in Frankland Jail, a high security prison in County Durham in northeastern England. He pleaded not guilty in court and has refused all entreaties to discuss the cases or to help the police and the families in any way.

The prosecutor in the case, Richard Henriques, shared his direct theory with the court for what drove the man who now ranks as the most notorious serial killer in Britain's history. ''He was exercising the ultimate power of controlling life and death,'' he said. ''And he repeated it so often that he must have found the drama of taking life to his taste.''