CCG death certificate error risks driving up GP workload

A leading GP has criticised CCGs for perpetuating a myth about death certificates with potentially 'horrendous' implications for GP workload.

Dr Paul Cundy: workload implications 'horrendous' (photo: Pete Hill)
Dr Paul Cundy: workload implications 'horrendous' (photo: Pete Hill)

CCGs in Sutton and Merton, London, were forced to apologise after a letter they sent to practices stated incorrectly that death certificates can only be signed by a doctor who has seen the patient in the previous 14 days, or since their death.

GPC member Dr Paul Cundy said the letter repeated a common myth that end-of-life patients need to be seen by their GP every two weeks, causing workload problems for practices.

‘We have several nursing homes on our list and we are being told all the time: "You haven't seen them for 14 days",' said Dr Cundy.

The letter, sent in February and signed by Dr Clare O’Sullivan, GP clinical lead for end-of-life care community services, said CCGs received the advice from the senior coroner for south London.

Erroneous CCG advice

It advised practices: ‘The doctor signing the certificate must: Have seen and treated the patient in their last illness. Seen the patient in the last 14 days prior to death OR after death. And to the best of their knowledge and belief certify the patient died from the stated cause.'

In April, following Dr Cundy’s intervention, Dr O’Sullivan sent an email correcting the ‘inaccuracies’.

She wrote: ‘The law requires GPs to issue a death certificate if they have attended a patient in their final illness. There is no legal requirement to have seen the patient within 14 days of death or to have to see the body after death.’

The confusion appears to come from the law regulating registrars which requires them, not GPs, to notify the coroner if the doctor signing the certificate has not seen the patient in the previous 24 days.

‘I am concerned that the coroner appears to not understand what must be a pretty basic part of the law in which he operates,' said Dr Cundy.

Workload implications huge

‘Although [the CCGs] were given advice by a coroner,’ he added, ‘I would have expected an end-of-life care lead to know what the proper arrangements were.'

Local GPs who contacted Dr Cundy said they had believed the incorrect information sent out by the CCGs.

‘The possible repercussions were that GPs would think, and more importantly people who run nursing homes and carers in the community would believe, that a patient needs to be seen every two weeks because they might die,' he said.

The implications for GP workload were ‘horrendous’.

In her correction Dr O’Sullivan apologised to GPs ‘for any confusion which may have been caused or any inconvenience’.

In a joint statement, Merton and Sutton CCGs, said: ‘Regrettably our original communication did contain some inaccuracies about the procedures surrounding the signing of death certificates. As soon as the error was recognised, corrections and apologies were issued via email - the same route as the original communication.’

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