Implementation
The Medical Examiner System was placed on a statutory footing via the Health and Care Act 2022 and whilst a ministerial announcement in June 2022 and a letter from NHS England in July 2022, confirmed plans to implement it on a statutory basis with effect from 1 April 2023, a further ministerial announcement on 27 April 2023 confirmed that the implementation date has been deferred until April 2024.
Whilst we are aware that there is a view that the absence of implementation details means that there is no contractual or statutory requirement on practices to meet requests from their local medical examiner (ME), to make the subsequent implementation as smooth as possible for GPs, and for families of any patient identified as a non-coronial death and considered under the new system, practices may want to discuss implementation with local ME offices and engage with those involved.
The purpose of this guidance is to explain the role and function of the medical examiners and what will be expected of you and your practice, in readiness for the statutory implementation of the Medical Examiner System.
Which deaths require notification to the coroner?
The obligation to notify deaths to the coroner can be found at the below link:
Notification of Deaths Regulations (2019) (amended March 2020)
If the death does not fulfil the definitions as outlined in the above link, then it will amount to a non-coronial death and therefore will require medical examiner scrutiny (if you are unsure as to whether a death requires referral to the coroner, then the medical examiner will be able to advise you).
What is a medical examiner?
Medical examiners are senior medical doctors, who are trained in the legal and clinical elements of death certification processes.
The role of the medical examiner includes:
- Reviewing the medical records.
- Liaising with the doctor who treated the patient in their final illness.
- Agreeing the proposed cause of death with the attending doctor and the overall accuracy of the medical certificate cause of death.
- Discussing the proposed cause of death with the next of kin, ensuring they understand any medical terms and providing an opportunity for them to raise any concerns, comments or compliments that they may have.
- Acting as a medical advice resource for the local coroner.
- Ensuring any concerns about the care of the patient are acted on appropriately (and if possible that any compliments are relayed to the relevant person[s]).
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.
Medical examiner offices
Medical examiner offices in London are hosted by acute trusts – your local medical examiner office(s) should have been in contact with your practice in order to explain how they intend to roll-out the Medical Examiner System between now and April 2023. If you are not in contact with your medical examiner office you should contact them using the details below.
The table below sets out how medical examiner offices map onto London boroughs.
| Trust/Medical examiner office | London borough(s) |
| Barking, Havering & Redbridge NHS Trust | Barking & Dagenham, Havering and Redbridge |
| Barts Health NHS Trust | City, Newham, Tower Hamlets and Waltham Forest |
| Chelsea And Westminster Hospital NHS Foundation Trust | Kensington & Chelsea and Hounslow |
| Croydon Health Services NHS Trust | Croydon |
| Epsom And St Helier University Hospitals NHS Trust | Sutton |
| Guy’s And St Thomas’ NHS Foundation Trust | Southwark and Lambeth |
| Homerton University Hospital NHS Foundation Trust | Hackney |
| Imperial College Healthcare NHS Trust | Hammersmith & Fulham and Westminster |
| Kingston Hospital NHS Foundation Trust | Kingston and Richmond |
| King’s College Hospital NHS Foundation Trust | Bromley and Bexley |
| Lewisham And Greenwich NHS Trust | Lewisham and Greenwich |
| London North West University Healthcare NHS Trust | Ealing, Brent and Harrow |
| North Middlesex University Hospital NHS Trust | Enfield and Haringey |
| Royal Free London NHS Foundation Trust | Barnet |
| St George’s University Hospitals NHS Foundation Trust | Wandsworth and Merton |
| The Hillingdon Hospitals NHS Foundation Trust | Hillingdon |
| University College London Hospitals NHS Foundation Trust | Camden |
| Whittington Health NHS Trust | Islington |
Referral to the medical examiner
In the case of a non-coronial death, the GP who intends to issue the MCCD will need to notify the relevant medical examiner office (this will usually involve completing a brief standardised form and sending it by email to a prescribed email address).
Access to the medical records
Medical examiners will have a statutory right of access to the records for the purposes of their role. The current position is that whilst the legislation is updated, to ensure information governance and data protection requirements are fulfilled, for the period before the statutory system commences, NHS England submitted an application under Regulation 5 of the Health Service (Control of Patient Information) Regulations 2002 (‘section 251 support’) to process confidential information without consent.
The approved application (which has been extended until 31 March 2024) can be found on the Health Research Authority (HRA)’s website (ref: 21/CAG/0032). The HRA’s Confidentiality Approval Group approval covers the sharing of medical records of deceased patients or the equivalent access to view those records with both medical examiners and medical examiner officers. It is expected that medical examiners will be added to the list of persons with a right of access to patient records in the Access to Health Records Act (1990) when the Medical Examiner System moves onto a statutory footing.
Issuing the Medical Certificate of Cause of Death (MCCD)
Once the medical examiner has reviewed the information on the referral form and has reviewed the medical records, 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 may take place by either email and/or a telephone conversation).
The medical examiner will speak with the bereaved family to enquire if they have any concerns regarding the care provided to their relative, discuss the proposed entries for the MCCD, ensure they understand the medical terminology being used and give them an opportunity to ask any questions they may have about the proposed cause of death.
After the Medical Examiner scrutiny has been satisfactorily completed (review of the records, speaking with the attending doctor and speaking with the bereaved family member) the Medical Examiner will authorise the release of the MCCD.
There will be the provision to issue a MCCD (where appropriate) promptly in circumstances when for religious (or other reasons) this is required. However, the same level of scrutiny by the Medical Examiner’s office is still required to occur for every death.
Other resources
- The national medical examiner system (NHS England)
- NHS England medical examiner updates, (the most recent one was in December 2022, which we shared via the Londonwide LMCs newsletter that month).
- Implementing the medical examiner system – good practice guidance
- Medical examiners and general practice (informative video in which two GP medical examiners discuss their experience of the Medical Examiner System to date).