Certifying deaths after the Coronavirus Act expires

Dr Udvitha Nandasoma, medico-legal adviser at the MDU, explains the process for certifying deaths in England and Wales now the Coronavirus Act has expired.

A UK death certificate
(Photo: stocknshares/Getty Images)

The Coronavirus Act 2020 introduced changes to the process of death certification recognising the difficulties created by the pandemic. In particular, it recognised that the doctor who saw the patient during their last illness may be unable to sign the certificate.

In England and Wales, these easements expired at midnight on 24 March 2022 although some changes have been retained on a permanent basis. Below we explain the key points from the latest guidance.

Who can complete an MCCD?

It will remain the case that a doctor who saw the patient within 28 days of their death can complete the medical certificate of cause of death (MCCD) rather than the 14-day period that existed before the Act.

However, the change allowing any medical practitioner to complete the MCCD has not been retained. It will again be the case that only a medical practitioner who attended the deceased during the 28 days of their last illness, or viewed the body in person after death, will be allowed to complete the MCCD.

Seeing the patient during their last illness can include consultations using video technology but not consultations with telephone/audio only. Attendance after death to view the body will need to be in person, including to verify the death.

It will also remain acceptable for medical practitioners to send MCCDs to registrars electronically. The MCCD can be scanned or photocopied and sent from a secure email account to the registrar. Family members (the informant or next of kin) will again have to register deaths in person.

What if the patient wasn’t seen immediately before death?

If the medical practitioner didn’t attend the deceased during the last 28 days before their death, or the deceased had not been seen after death, the MCCD can still be completed if the medical practitioner can state the cause of death to the best of their knowledge and belief. If the MCCD is completed on this basis, the death will need to be notified to the coroner preferably by the medical practitioner before registration. This can also be done by the informant at the time of registration.

If the cause of death cannot be stated, the coroner must be notified so that the cause of death can be determined. 

What impact will this have on cremation forms?

Where a patient has died in England, Wales or Northern Ireland and is to be cremated, a separate cremation form needs to be completed. Under the expired Act, cremation no longer required the confirmatory medical certificate (cremation form 5), but still required the completion of the medical certificate (cremation form 4).

From 24 March, a medical practitioner will be able to complete the form Cremation 4 if they attended the deceased (through either a face to face or video consultation) within 28 days before death or viewed the body in person after death (including for verification). The requirements will therefore be the same as those for the MCCD.

The government has said it does not intend to re-introduce cremation form 5 once the Act expires.

I’m based in Scotland – what should I do?

In Scotland, even before the changes introduced as a result of coronavirus it was possible for another medical practitioner to provide an MCCD if no registered medical practitioner had attended the deceased during their last illness, or if the attending practitioner was unable to provide a certificate. The coronavirus provisions allowing for electronic transmission of MCCDs and an informant to remotely register the death will remain in place until 24 September 2024.

New format MCCDs were introduced in Scotland in 2015, eliminating the need for doctors to complete separate cremation forms.

What should doctors in Northern Ireland do?

The system for death certification in Northern Ireland will revert to the pre-covid position once the Act expires. This means that the deceased must have been attended by the medical practitioner completing the MCCD in the 28 days prior to their death.

The provisions allowing a cremation to proceed on the basis of a single medical certificate (such as without the confirmatory medical certificate ‘Form C’) have been extended until 24 September 2022.

Contact the MDU or your medical defence organisation if you are unsure about signing a death certificate or cremation form.

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