The process of death certification in England requires a registered medical practitioner to certify the cause of death to the best of their knowledge and belief. Alternatively, if the circumstances require further investigation, the death must be reported to the coroner, who will then provide the appropriate certification.
There is no legal requirement for a doctor to have seen the deceased within 28 days before or at any time after death to complete the Medical Certificate of Cause of Death (MCCD).
However, if the deceased has not been seen by a doctor in the 28 days prior to death or at any time after death, the registrar will automatically refer the case to the coroner for further review.
To avoid unnecessary delays in registration and potential referrals to the coroner, it is strongly advised that the doctor completing the MCCD has seen the patient within the last 28 days before death whenever possible.
The Medical Examiner (ME) system is now being rolled out nationally to provide independent scrutiny of all deaths that are not investigated by the coroner. This process is designed to improve the quality and accuracy of death certification, ensure that families have a clearer understanding of the cause of death, and enhance transparency in the system.
What This Means for GPs:
The Medical Examiner will review all non-coronial deaths to ensure the MCCD is completed accurately and appropriately.
Families will have the opportunity to discuss the cause of death with the Medical Examiner, helping to address any concerns at an early stage.
The Medical Examiner may request additional clarification from the certifying doctor, which may require further input before the MCCD is finalised.
This additional layer of scrutiny aims to reduce inconsistencies in certification and improve public confidence in the process.
Whenever feasible, ensure you have seen patients within 28 days before death to minimise coroner referrals.
Be prepared for possible follow-up from the Medical Examiner regarding the certification of death, especially if there are uncertainties or inconsistencies.
Engage with bereaved families when appropriate, offering clarity on the cause of death and signposting them to additional support if needed.
Stay informed about your local Medical Examiner office processes, as regional variations may exist in implementation.
The introduction of the Medical Examiner system represents a significant change in death certification procedures. GPs should familiarise themselves with these changes to ensure compliance, reduce delays, and provide the best possible care to patients and their families during this sensitive time.