All you wanted to know about medical examiners, but were afraid to ask

  • General guidance

Context

GP practice will have received correspondence from NHS England dated 8 June 2021 about the roll-out of the medical examiner system into the non-acute setting. The purpose of this guidance is to set out what the medical examiner system is, how it applies to general practice and what is/will be required of GPs.

Current position

The medical examiner role is already established in the acute setting, and it was always the intention to extend medical examiner scrutiny to all non-coronial deaths – what is not entirely clear is the timing of the roll-out – the current position is that no immediate action is required but local medical examiners’ offices will contact GPs in due course.

Legislative position

There is an intention to put the medical examiner system onto a statutory footing (it is anticipated that this will be a statutory requirement from April 2022) and it will mean that all deaths that are not referred directly to the coroner (please refer to the information under the heading The Notification of Deaths Regulations [2019]) will need to go through the medical examiner system.

Summary of implications for GPs

The medical examiner system will undoubtedly increase the work for GPs surrounding the completion and issuing of MCCDs (please refer to further comments below under the heading What will be required of GPs in relation to non-notifiable deaths?).

The medical examiner system does have potential benefits particularly in relation to improving the overall quality and consistency of death certification and mortality data, together with the fact that the medical examiner will assist in explaining the wording of the MCCD to the bereaved.

Aims of the medical examiner system

The stated aims of the medical examiner system are summarised below:

  • To provide greater safeguards for the public by ensuring proper scrutiny of all non-coronial deaths.
  • To ensure the appropriate direction of deaths to the coroner.
  • To provide a better service for the bereaved and an opportunity for them to raise any concerns to a doctor not involved in the care of the deceased.
  • To improve the quality of death certification.
  • To improve the quality of mortality data.

The approach of medical examiners

In order to achieve the above aims, the medical examiners will:

  • Agree the proposed cause of death and the overall accuracy of the medical certificate of cause of death (MCCD) with the doctor completing it.
  • Discuss the cause of death with the next of kin/informant and establish if they have questions or any concerns with care before death.
  • Act as a medical advice resource for the local coroner.
  • Inform the selection of cases for further review under local mortality arrangements and contribute to other clinical governance procedures.

The Notification of Deaths Regulations (2019)

GPs should be mindful of their obligations to notify deaths to the coroner as per the Notification of Deaths Regulations (revised March 2020).

What will be required of GPs in relation to non-notifiable deaths?

GPs will be required to provide the following information to the medical examiners in relation to non-notifiable deaths:

  • The medical records, including (as a minimum):
    • A summary.
    • The previous medical history.
    • The prescribing history.
    • The last 3 months of the clinical records and hospital correspondence.
    • Any other information that the GP deems relevant/necessary to provide.

Once the medical examiner has had chance to review the above information, there will need to be a dialogue between the GP (who is completing the MCCD) and the medical examiner in relation to the proposed cause of death before the MCCD is completed (it is anticipated that this dialogue will usually take place via email).

The medical examiner will provide the bereaved family an opportunity to ask questions about the proposed cause of death. The GP will then submit the MCCD electronically to the medical examiners’ office, who will then authorise its release.

There would need to be the provision to issue a MCCD (where appropriate) promptly in circumstances when for religious (or other reasons) this is required, and the medical examiners will be only too mindful of such circumstances.

Other resources

The national medical examiner system (NHS England)

Implementing the medical examiner system – good practice guidance