GPs in England and Wales who are notified of a patient death will need to work more closely with medical examiners under plans to examine deaths not referred to a coroner.
In an update provided by the national medical examiner Dr Alan Fletcher, it has been announced that the medical examiner system is now expanding out from acute trusts to include community settings, including GP practices. This will involve scrutiny by a medical examiner of all non-coronial deaths in England, with the process for community deaths already having started in Wales.
Who are medical exmainers?
There are over 1,200 trained medical examiners who are senior doctors from a range of specialties. They provide independent scrutiny of deaths which are not investigated by the coroner.
Medical examiner offices have been set up and will work with GP practices to plan how the system will work locally. GPs should be contacted during 2021/22 to discuss the process of scrutinising deaths in the community.
The appointment of medical examiners has been a key component for the improvements to the death certification process in England and Wales. The need for change was highlighted by a number of reports, including the Shipman Inquiry report and later by reports about Mid-Staffordshire and Morecambe Bay hospitals.
How will the system work?
A priority of the system is to give bereaved relatives an opportunity to have a voice, ask questions and, if necessary, raise concerns. The patient’s attending doctor will sign the Medical Certificate of the Cause of Death (MCCD) after discussion and agreement with the medical examiner following review of the relevant patient records.
Medical examiners can offer GPs support with complex cases, administrative elements of notifications to coroners where agreed, and reduced administration.
The NHS guidance on their extension to primary care explains that there is no need for a verbal discussion with the examiner unless the GP would find this helpful – an email exchange of correspondence will normally suffice.
In most cases the examiner will receive access to relevant parts of the patient records and practice staff may be involved in helping to put together a suitable summary.
Sharing patient records
There is a legal basis for the records of deceased patients to be shared with the examiner for scrutiny as set out in The National Health Service Trust (Scrutiny of Deaths) (England) Order 2021.
This order confers power on NHS trusts to scrutinise under the medical examiner framework any death in England, regardless of whether the death takes place in the trust’s area, where the coroner does not have a duty to investigate.
Deaths can also be scrutinised by a medical examiner if there is doubt as to whether a death must be notified to the coroner. It is hoped that all deaths in England, including those in a non-acute settings, will be subject to medical examiner scrutiny by the end of March 2022.
Benefits established to date, by the medical examiner system, have included a reduction in the number of rejected MCCDs, improved referrals to coroners and support with expediting the release of a body, for example in faith communities, where urgent issue of the MCCD is needed.
GPs with queries about certifying deaths or the role of medical examiners are welcome to contact the MDU or their own medical defence organisation for further advice.
- Kathryn Leask is a medico-legal adviser at the MDU