Pursuant to the Medical Certificate of Cause of Death Regulations 2024, the new statutory medical examiner (ME) system was rolled out last month across England and Wales to provide independent scrutiny of deaths. From 9 September 2024 all deaths, including those in the community, that are not investigated by a coroner must be reviewed by MEs. The changes form part of the death certification reforms.

These reforms aim to simplify the previous rules, which required the case to be referred to a coroner for review if the attending practitioner had not seen the patient within 28 days of death or had not seen the patient after death in person. The reforms should increase the number of doctors eligible to sign the medical certificate cause of death (MCCD) and avoid delays in certifying deaths, especially where staff are on leave or unavailable. In addition the revised ME system aims to provide a better service for the bereaved and give them an opportunity to raise concerns with a doctor not involved in the deceased’s care.

Key changes

• There is now a statutory requirement for all non-coronial deaths to be referred to the ME office before a death certificate can be provided.
• Cases that have to be referred to the coroner will not change, but a coroner can request a ME to review a case.
• MEs will complete a review of the deceased’s medical records and will speak with the deceased's family, giving them an opportunity to ask questions or raise concerns. This aims to provide a forum for concerns to be addressed at an early stage - potentially preventing complaints.
• A medical practitioner will be eligible to complete the MCCD if they attended the deceased in their lifetime (rather than within 28 days of the death). The attending doctor will propose a cause of death in the MCCD and submit this to the ME to scrutinise the case.
• The ME, not the attending practitioner, will submit the MCCD to the registrar.
• The new MCCD will include new information such as ethnicity (as declared by the patient in their records), pregnancy status, recording of any medical devices and implants in situ, and includes a new ‘1d’ line in the cause of death to bring the document in line with international standards.
• The senior coroner can refer the death for certification by the ME in the exceptional circumstances where there is either no attending practitioner or where an attending practitioner is not available within a reasonable time frame to complete the MCCD.

The Notification of Death Regulations 2019 remain in force (subject to minor amendments), meaning that attending practitioners should continue to notify the coroner of all deaths that fall within the regulation criteria. Where an attending practitioner notifies the coroner of a death directly, there is no requirement for that attending practitioner to inform the ME of this. Cases can also be referred to the coroner by the ME if they do not feel they can complete the MCCD. 

What do these changes mean?

NHS Trusts should:

• ensure that the ME office is supported to act in line with the updated ME system

• confirm that they have made the necessary arrangements to inform a ME of an individual’s death and have processes in place to share the deceased’s medical records in a timely manner.

Healthcare providers, including GP practices, should:

• have in place the necessary arrangements to inform the ME’s office of deaths requiring independent scrutiny

• create processes to share records of deceased patients with MEs in a timely manner.

ICBs should:

• Contact healthcare providers in their area to ensure they have established processes to refer Relevant deaths to ME offices for independent review.

Attending doctors should:

• share the MCCD and proposed cause of death with MEs promptly

• be available to receive feedback from the ME’s office to allow for learning and development

• stay up-to-date with guidance on completing a MCCD and abreast of GMC requirements on end of life care.

How Capsticks can help

Capsticks can support your organisation following the implementation of the reformed medical examiners system. Where a death has been referred to the coroner and you have been informed an inquest has been opened, Capsticks can help to protect your organisation’s reputation and give your staff the support they need in the lead-up to, and during, an inquest. We have one of the largest inquest teams in the country, representing all types of service providers at around 1,400 inquests a year.

Our experts will be discussing the Patient Safety Incident Response Framework (PSIRF) one year on and its impact on inquests and inquest preparation and Prevention of Future Deaths evidence in an upcoming webinar. To register your interest, please RSVP here.

Additionally, On Thursday 28 November, members from our Advisory team will provide an overview of case law developments and inquest practice over the last year and a thematic review of Prevention of Future Deaths Reports in 2023/24.  To register your interest, please RSVP here.

If you have any queries around what's discussed in this insight, and the impact on your organisation, please contact Georgia Ford or Clara McNeill to find out more about how Capsticks can help.