GPs in England and Wales who are notified of a patient death will need to work closely with medical examiners to allow them to independently scrutinise deaths not referred to a coroner. This will include sharing records of deceased patients.
In an update in June 2021 Dr Alan Fletcher, the national medical examiner, announced that the medical examiner system was expanding out from acute trusts to include community settings, including GP practices. This would involve scrutiny by a medical examiner of all non-coronial deaths in England, with the process for community deaths already having started in Wales.
In a recent update NHS England advised that ministers had announced their intention for the statutory medical examiner system to start from April 2023. In preparation for this, all NHS organisations should have processes in place to facilitate the work of medical examiners in place by 31 March next year.
Who are medical examiners
Medical examiners 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 help plan the system locally.
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 NHS hospital trusts.
A priority of the system is to give bereaved relatives an opportunity to have a voice, ask questions and, if necessary, raise concerns. The 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 and administrative elements of notifications to coroners where agreed, thus reducing administration involved.
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
Currently, the legal basis for the review of deaths by medical examiners is set out in The National Health Service Trust (Scrutiny of Deaths) (England) Order 2021. This order gives power to NHS trusts to scrutinise any death in England, regardless of whether the death takes place in the trust’s area. This includes deaths in the community, 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.
All healthcare providers need to develop and implement arrangements to share medical records of deceased patients with their local medical examiner office.
When the statutory medical examiner system starts there is an expectation that there will be a modification of the Access to Health Records Act 1990, to include medical examiners in the list of persons with a right of access to patient records.
Prior to this, the current provision for information governance and data protection under Regulation 5 of the Health Service (Control of Patient Information) Regulations 2002 (‘section 251 support’) allows sharing of records for the purposes of scrutinising a death.
To date, the medical examiner system, has led to a number of benefits including a reduction in the number of rejected MCCDs and improved referrals to coroners. Another benefit has been 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 their medical defence organisation for further advice.