Information for primary care on East and North Herts Medical Examiner Office
A new statutory medical examiner system is being rolled out across England and Wales to provide independent scrutiny of deaths, and to give bereaved people a voice. From 9 September 2024 all deaths in any health setting that are not investigated by a coroner will be reviewed by Medical Examiners. The changes form part of the Department of Health’s Death Certification Reforms which were announced by the government on 15 April 2024, and come into force on 9 September 2024. As part of the changes, there will be a new medical certificate of cause of death (MCCD). From 9 September 2024, medical practitioners will be able to complete an MCCD if they attended the deceased in their lifetime. This represents a simplification of the current rules, which before 9 September requires referral of the case to a coroner for review if the medical practitioner had not seen the patient within the 28 days prior to death or had not seen in person the patient after death.
Introduction
The Medical Examiner office at East and North Herts Trust provides independent scrutiny of all non-coronial deaths occurring in Lister Hospital and the surrounding community. Once the new death certification process comes into force on 9 September 2024, all deaths in East and North Herts will be independently reviewed, without exception, either by a medical examiner or a coroner.
The East and North Herts Medical Examiner office has 12 Medical Examiners; senior doctors from a range of specialties including general practice, and who provide independent scrutiny of deaths not taken at the outset for coroner investigation. The Medical Examiners are supported by a team of 1 Lead Medical Examiner Officer and 4 Medical Examiner Officers. They put the bereaved at the centre of processes after the death of a patient, by giving families and next of kin an opportunity to ask questions and raise concerns. Medical examiners carry out a proportionate review of medical records, and liaise with doctors completing the Medical Certificate of Cause of Death (MCCD).
What medical Examiners do
Medical examiners’ conclusions can inform learning to improve care for future patients, or, in a smaller number of cases, may be referred to others for further review. Their involvement also provides reassurance to the bereaved.
Medical examiners seek to answer three questions:
- What caused the death of the deceased?
- Does the coroner need to be notified of the death?
- Was the care before death appropriate?
Medical examiners answer these by providing independent scrutiny, with three elements:
- A proportionate review of relevant medical records
- Interaction with the doctor completing the Medical Certificate of Cause of Death
- Interaction with the bereaved, providing an opportunity to ask questions
How medical examiners can benefit primary care
Medical Examiners are already delivering benefits including fewer rejected MCCDs, improved referrals to coroners, improvements to patient care, and positive feedback from certifying doctors and bereaved people. Potential benefits for GPs include:
- Supporting the bereaved: For GPs, this can reduce workload by taking care of enquiries and follow-ups. This does not replace GPs speaking with families or next of kin, and providing the support they wish to give.
- Support with MCCD completion: specialist training and understanding of the MCCD and death certification processes means medical examiners can reduce the burden associated with coroner notifications from GP practices.
- Supporting work with coroners’ offices: medical examiners are a source of medical advice for coroners, which should reduce requests from coroners for GPs to discuss cases or advice on wording.
- Reduce administration: The medical examiner officers can carry out administrative tasks relating to death certification, such as completing a coroner’s referral directly to the coroner via their portal
- Timely completion of scrutiny: medical examiners complete their scrutiny in a timely manner to facilitate registration within five days.
- Complex cases: medical examiners will support the doctor completing the MCCD, drawing on their extensive knowledge gained through training and regular exposure to more complex scenarios to support and advise. This will assist GPs in completing MCCDs accurately in more complex cases.
- Urgent release of the body: medical examiners will develop positive relationships with contacts in faith communities, and will be able to support GPs if there are requests for urgent issue of the MCCD.
- Clinical governance; where issues are detected, medical examiners will offer non-judgmental feedback. Their aim is not to find fault or review in unnecessary detail.
- Concerns and learning; a key objective for the medical examiner system is to identify constructive learning to improve care for patients.
Interaction with medical examiners
The interaction between the GP completing the MCCD and the Medical Examiner can usually take place through email correspondence (without the need for a verbal discussion) and the usual entries in the patient record. However, verbal a discussion is welcome if the GP would find it helpful. Medical Examiner officers provide continuity in the office and are available through the working week.
What do GPs need to do?
Following a death in the community, GP practices should complete a notification of death referral form (the template can be found on Ardens) and email this to the medical examiners office. Please send the referral as soon as you have been notified of the death. This will minimise any disruption or distress for bereaved families.
As well as sending the last three months of patient notes, please also use the referral form to provide a brief summary of the events leading to the death. This will help the Medical Examiner to have a better understanding of the circumstances as sometimes this is not clear in the patient notes.
Sharing records of deceased patients with medical examiners
When the statutory Medical Examiner System commences on 9 September 2024, the Access to Health Records Act 1990 will give Medical Examiners the statutory right to access the medical records of deceased patients from the holders of those records, including GP practices.
For the period before the statutory Medical Examiner System commences, the Secretary of State for Health and Social Care has approved the use of confidential patient information for the purposes of the non-statutory medical examiner system, under section 251 of the National Health Service Act 2006 and Regulation 5 of the Health Service (Control of Patient Information) Regulations 2002 (‘section 251 support’). This section 251 support is in place until 8 September 2024 and enables healthcare providers, including GP practices, to share the medical records of deceased patients with Medical Examiners.
Medical records of deceased patients are outside the scope of UK GDPR, however healthcare providers may share (and medical examiner offices may process) contact details of deceased patients’ next of kin in accordance with Article 6.1(e) UK GDPR (processing that is necessary for the exercise of a public task). Medical examiner offices are based in NHS trusts/foundation trusts which process personal data in accordance with all applicable legal and NHS requirements including UK GDPR.
Changes to the death certificate process from 9th September 2024
As of 9 September 2024 12:01am the new MCCD will need to be used. The department of Health and Social Care are responsible for the new MCCD and will send these directly to each GP practice.
More information about the medical certificate of cause of death regulations 2024 can be found on the Legislation.gov.uk website.
There are a number of changes to the MCCD, which include a line 1D, the ability to record maternal deaths and if the deceased has a pacemaker.
The Registration Service will no longer accept MCCD’s directly from GP Practices. Every MCCD must be sent to East and North Herts Trust in order for the Medical Examiner to counter sign them before being sent to Hertfordshire Registration Service. Each MCCD will be sent to the Registration Service by the Medical Examiner Officers.
Any GP who has seen the patient in a lifetime can complete the MCCD. The requirement for within 28 days will no longer be the case.
There will be no requirement to see the body.
There cremation form 4 will no longer be required; there will be no replacement for this form.
Opening Hours
Monday to Friday (excluding bank holidays) 08:00 – 16:00
Contact Us
You can contact the Medical Examiner office on 01438 288463, or you can email us at [email protected]
Useful Links
Department of Health and Social Care Announcement
Receiving the new medical certificate of cause of death (MCCD)
