The MDU’s advice comes after recent figures published by the Office for National Statistics (ONS) demonstrated that a quarter of death certificates in England and Wales could be inaccurate, highlighting the need for GPs to be aware of the regulations for death certification.
New medical examiners, medically qualified government officers whose duty is to investigate deaths, are due to be introduced in April 2014 in England and Wales following pilot schemes in Sheffield and other parts of the country.
In the Sheffield pilot, a detailed examination of over 8,000 death certificates showed that in 2,000 the cause of death was not accurate and failed to identify the root cause, for example citing pneumonia as the cause of death in a patient with metastatic cancer. Many doctors were also unsure when to refer cases to the coroner.
These figures correspond with an analysis of MDU’s files in which members have asked for assistance from the MDU.
Over a recent five-year period, 130 files were opened, with most queries being raised by GPs, although a minority were from hospital doctors and consultants.
Of the 130 files, over a fifth of cases were complaints filed against doctors due to allegedly inaccurate certificates. Ten of these were coroner’s cases. In one case the coroner requested a hospital investigation and in two others the doctors were reported to the GMC as a result of the inaccuracy of the certificate and management of the patient.
The second highest number of files (19%), were in regard to members wanting advice about completion of certificates, for example on how to correctly declare the death.
Sixteen per cent of MDU’s cases were due to alleged delays in issuing certificates. In two cases this resulted in delays to the funeral. In one case the doctor was referred to the GMC and in the other the complaint was referred to the Ombudsman.
A spokesperson for the MDU told GP that when completing the death certificate, GPs need to make sure to 'do it quickly and accurately. You don’t want to be causing any unnecessary delays, which can lead to a complaint in itself'.
GPs also need to know when to refer a case to the coroner, as some circumstances prohibit GPs from issuing the certificate.
These include:
- No doctor attended the deceased during his or her last illness
- Although a doctor attended during the last illness the deceased was not seen either within 14 days before death nor after death
- The cause of death appears to be unknown
- The death occurred during an operation or before recovery from the effects of an anaesthetic
- The death occurred at work or was due to industrial disease or poisoning
- The death was sudden or unexpected
- The death was unnatural
- The death was due to violence or neglect
- The death was in other suspicious circumstances
- The death occurred in prison, police custody or other state detention.
The MDU also wanted to remind GPs of their ethical obligations. GMC guidance End of Life Care (2010) says that if there is any information on the death certificate that those close to the patient may not know about, may not understand or may find distressing, you should explain it to them sensitively and answer their questions, taking account of the patient's wishes if they are known.
The MDU concluded that when in doubt, GPs should seek contact with the MDU or coroner for advice.
