Notification of Deaths Regulations 2019 – Guidance

The Notification of Deaths Regulations 2019 (NDR) come into force on 1 October 2019, imposing a duty on medical practitioners to report deaths where:

• they are unable to ascertain the cause of death;
• the cause of death is unnatural, or;
• the death occurred in custody or state detention.

The regulations also place a duty on medical practitioners to report deaths to the coroner where:

• no attending practitioner is required to sign a Medical Certificate of Cause of Death (MCCD);
• an attending practitioner is required to sign a MCCD but they are unavailable;
• or the identity of the deceased is unknown.

In its response to a 2016 consultation,^[1] the government committed to creating a statutory duty on medical practitioners to report deaths to the coroner in certain circumstances. The aim of the enhanced duty is to improve the consistency of referrals of deaths to the coroner. The 2019 NDR replace the 2014 Regulations of the same name.

Guidance for registered medical practitioners

Notification requirement:

It is intended that one of the attending medical practitioners who is qualified to complete the MCCD will make the notification to the senior coroner.

Deaths may be reported to the coroner by people other than medical practitioners such as family members of the deceased, or the police. Where this has happened, it is important that a notification is still made by the medical practitioner under the NDR so that the full medical details are established under regulations 4(3) and (4).

Circumstances in which the duty to notify arises

• Where the registered medical practitioner suspects that that the person’s death was due to—
  • poisoning, including by an otherwise benign substance;
  • exposure to or contact with a toxic substance;
  • the use of a medicinal product, controlled drug or psychoactive substance;
  • violence;
  • trauma or injury;
  • self-harm;
  • neglect, including self-neglect;
  • the person undergoing a treatment or procedure of a medical or similar nature; or
  • an injury or disease attributable to any employment held by the person during the person’s lifetime;^[2]
• The person’s death was unnatural but does not fall within any of the above circumstances;
• The cause of death is unknown;
• The registered medical practitioner suspects that the person died while in custody or otherwise in state detention;
• The registered medical practitioner reasonably believes that there is no attending medical practitioner required to sign a certificate of cause of death in relation to the deceased person;
  • Only an attending medical practitioner – a registered medical practitioner who attended the deceased during his/her last illness before his or her death – can complete an MCCD. Any MCCD that has not been completed by an attending medical practitioner who has seen the deceased either in the 14 days prior to the date of death, or after death, must be reported to the coroner by the Registrar.[3]
• The attending medical practitioner is not available within a reasonable time of the person’s death to sign the certificate of cause of death;
• The identity of the deceased person is unknown.

Changes from the 2014 Regulations

The wording of the 2019 NDR is largely only cosmetically different to the 2014 Regulations, and includes much the same information in terms of reporting. However, the following changes are made to the reportable circumstances:

• Deaths caused by toxic ‘substances’ rather than ‘chemicals’ must be reported.
• Deaths by psychoactive substances must now be reported, with reference to the Psychoactive Substances Act 2016.
• Reportable poisoning deaths can now be caused by substances that are otherwise benign.
• The 2019 NDR have included the requirement to report a death occurring by: ‘undergoing a treatment or procedure of a medical nature’. This applies if the death may be related to surgical, diagnostic or therapeutic procedures and investigations, anaesthetics, nursing or any other kind of medical care. Practitioners should only notify where they believe that the death is due to the treatment, not where it is merely incidental to the death.
• Practitioners must now report deaths which they ‘suspect’ have occurred in custody or state detention, as opposed to deaths known to have occurred there.

Information to provide in the notification:

• The 2019 NDR adds the additional requirement to inform the coroner of the name of any consultant medical practitioner[4] who attended the deceased person during the period beginning with the fourteenth day before death and ending with the person’s death.
• The notification must include other information such as the practitioner’s details, and the details of the deceased and their next of kin. This information is the same as was required under the previous Regulations.
• The notification must only include ‘such of the… information as is known to the registered medical practitioner’.

The full guidance for practitioners can be found here:

• https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/831100/notification-deaths-regulations-2019-guidance.pdf

[1] Introduction of Medical Examiners and Reforms

to Death Certification in England and Wales, 2016

[2] NDR 2019, reg 3(1)(a)(i-ix).

[3] Registration of Births and Deaths Regulations 1987.

[4] a registered medical practitioner who is listed in the Specialist Register of the General Medical Council.