Substantial changes to the death certification process are incoming
22nd August, 2024
Changes to the death certification process are to be implemented from the 09 September 2024, to ensure that all deaths are independently scrutinised by a Coroner or a Medical Examiner. In practice, this intends to place the existing informal position into law.
Here we briefly outline the new process, the key roles within such process, and the actions that may need to be taken by your organisation in response to such changes.
The key developments to be aware of include:
- The role of the Attending Practitioner
- The role of the Medical Examiner
- Independent Certification by the Medical Examiner
- The role of the Coroner
- Changes to Death Registration
- Changes to Death Certificates
Actions for your organisation
NHS Trusts which have their own Medical Examiner’s office in-house must ensure that this office is supported, in so far as possible, in rolling out the new procedure and corresponding systems as outlined below. This must be done without infringing upon the Medical Examiner’s independence and impartiality. In the event that your Trust has such an office, it would be advisable for you to make enquiries with the Medical Examiner to determine if you can provide any additional resources or support in getting ready to implement these changes prior to 09 September 2024.
For all other healthcare providers, including GP practices and private providers, you must ensure that adequate processes are in place to notify the Medical Examiner of any relevant deaths. An efficient system must also be in place to share the relevant medical records with the Medical Examiner in the event of a death, to allow them to undertake the necessary records review in a timely fashion. If you require further guidance or support in implementing such systems, please do not hesitate to contact us directly for additional advice.
Finally, Integrated Care Boards are required to contact all relevant healthcare providers within their locality to ensure that they have established suitable processes for the referral of deaths to the Medical Examiner. Any provider without such processes in place should be advised to take immediate action to implement these processes without delay.
So what are the upcoming changes?
Role of the Attending Practitioner
The ‘Attending Practitioner’ is the individual who shall complete the new Medical Certificate of Cause of Death (“MCCD”). Any qualified medical practitioner will be able to complete the MCCD, so long as they attended upon the Deceased at some point during their life.
This simplifies the existing process as, currently, a death must be referred to a Coroner if the medical practitioner had not attended upon the Deceased in the 28 days leading up to their death, or following their death. This requirement will no longer apply.
In completing the MCCD, the Attending Practitioner will be required to suggest what they believe to be the cause of death to the best of their knowledge and belief. This will then be independently scrutinised by a Medical Examiner, if not referred to the Coroner.
Role of the Medical Examiner
‘Medical Examiners’ will be senior medical practitioners who have received specialised training and shall be contracted for a set number of sessions to review MCCDs.
The Medical Examiner will act as independent scrutiniser of the Attending Practitioner’s proposed cause of death. In doing so, the Medical Examiner will also conduct a proportionate review of the Deceased’s medical records and will act as the key point of contact for bereaved families with any questions or concerns.
All deaths not referred to a Coroner must be independently scrutinised by a Medical Examiner before the death can be registered. Once the Attending Practitioner has completed the MCCD, which has been scrutinised and confirmed as accurate by the Medical Examiner, the MCCD will be sent to the Registrar for registration. A representative of the Deceased will also be notified that they should contact the Registrar to arrange the registration of the death.
Independent Certification by the Medical Examiner
If there is no Attending Practitioner available and, upon referral to the Coroner, there is a decision by the Coroner not to investigate the death from a coronial perspective, the Medical Examiner can independently decide the cause of death and complete the MCCD. This is the only circumstance in which the Medical Examiner can independently certify a death and it is important that, beforehand, all avenues to identify an appropriate Attending Practitioner have been exhausted. The Medical Examiner is also expected to act with the same level of scrutiny that would be expected had they received the referral from an Attending Practitioner.
The Role of the Coroner
An Attending Practitioner should still notify the Coroner of any deaths that meet the criteria in the Notification of Deaths Regulations 2019. These are instances when the cause of death is suspected to be violent or unnatural, is unknown, or the death occurred whilst in State detention. In such cases, there is no requirement for the Attending Practitioner to also notify the Medical Examiner.
If the Coroner accepts jurisdiction to investigate the death, the existing coronial process will be followed. However, if the Coroner declines jurisdiction to investigate, the Attending Practitioner will be notified, and it will be for the Attending Practitioner to then refer the matter to the Medical Examiner for scrutiny.
Changes to Death Registration
A death will not be registered until a notification and MCCD is received by the Registrar from a Medical Examiner or from a Coroner. Only then will the 5-day timeframe commence for the death to be registered.
Once these changes are implemented, the Registrar will no longer refer matters to the Coroner. Instead it will be for Attending Practitioners and/or Medical Examiners to determine which matters require referral to the Coroner. The only interaction between a Coroner and a Registrar will be in respect of provision of an MCCD to the Registrar, following the conclusion of a Coroner’s investigation.
Changes to Death Certificates
Along with these changes, a new style of MCCD is to be introduced, which will capture the following additional details:
- The details of the Attending Practitioner and/or Medical Examiner.
- The ethnicity of the Deceased.
- Whether it is a maternal death.
- Whether the Deceased had any medical devices and/or implants.
Currently this updated version of the MCCD is only available in a paper format, although the Government anticipates being able to make an electronic copy available later in the year.
This additional information, along with the existing information, will be conveyed to the Office for National Statistics for their consideration and to allow for any trends to be recorded.
For further information, the official Government release can be found here.
Get in touch
If you would like any further advice or guidance in relation to the above, please do not hesitate to contact Joseph Beeney, Solicitor, at joseph.beeney@wardhaway.com or 0330 137 3394.
Please note that this briefing is designed to be informative, not advisory and represents our understanding of English law and practice as at the date indicated. We would always recommend that you should seek specific guidance on any particular legal issue.
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