NEW: Medical examiner process

The statutory implementation of medical examiner system will be coming to all NW London GP practices (under legislation in the 2022 Health and Care Act).  

To be compliant practices must be ready to use the new process on EMIS/SystemOne to refer deaths to the Medical Examiner’s Office - before a medical certificate for cause of death (MCCD) can be issued, for non-coronial deaths.

User guides to set your practice up:

SystmOne - guide

EMIS - user guide

All practices should attend a training session to support set-up on these systems - please see the NW London primary care bulletin for dates and times.

If you have IT set-up questions and cannot attend one of these training days please contact: tsmith8@nhs.net

What is the change to the death certificate process and why is it happening?

The statutory implementation of medical examiner system for all GP practices started on 9 September (under legislation in the 2022 Health and Care Act), along with some changes to the medical certificate of cause of death (MCCD).

The medical examiner system has been successfully running in our acute trusts for the last few years and the rollout to primary care completes the final stages of the nationwide process.  A medical examiner will review the clinical notes to agree the cause of death with you or suggest a referral to the coroner. As part of the process the medical examiner will speak to the bereaved and talk through any questions they have.

 

What does this mean?

The change means that all non-coronial deaths (non-acute sector) need to be referred to the local medical examiner’s office before a death certificate can be provided.

This will be done using a new pathway set up on EMIS/SystmOne TPP.
User guides can be found on the tab above.

 

Which GP can can complete the death certificate (MCCD)?

Any GP that has seen the patient in their lifetime, even if only once, as long as they can identify the cause of death.

If no GP in the practice has seen the patient, the death will need to be referred to the coroner.

If the only GP (who has seen the patient in their life) is on holiday – it will need to be decided what timescale is reasonable to wait to complete the MCCD (e.g. 5-7 days). If the GP is away longer it will need to be referred to the coroner.
 

How do GPs complete the section of the MCCD on devices if you can’t see the patients notes?

If you don’t know, you do need to check. The medical examiner office may also be able to help you find out more information.

For patients you don’t have access to records, it may be advisable to visit the patient to see if they have any devices that can be felt.

A full list of devices will be provided by DHSC soon – the following list has been shared by our local crematoria.

Implants that could cause issues during a cremation include but are not limited to:

• Pacemakers
• Implantable Cardioverter Defibrillators (ICDs)
• Cardiac resynchronization therapy devices (CRTDs)
• Implantable loop recorders
• Ventricular assist devices (VADs): Left ventricular assist devices (LVADs), Right
• ventricular assist devices (RVADs), or Biventricular assist devices BiVADs)
• Implantable drug pumps including intrathecal pumps
• Neurostimulators (including for pain & Functional Electrical Stimulation)
• Bone growth stimulators
• Hydrocephalus programmable shunts
• Fixion nails (battery powered saline filled cylinders inserted in bone in eg sarcoma surgery to grow with the patient)
• Any other battery powered or pressurised implant
• Radioactive implants
• Radiopharmaceutical treatment (via injection)

 

Where do cross boundary referrals go?

Refer the death to the medical examiner service in the borough where the death happened – if a cross boundary then the ME offices may need to have a conversation about who best to review. Do not send more than one referral.

If the GP has sent to the wrong ME office – the ME office will forward on to the correct office.
 

What do I do if the coroner returns a referral?

If the coroner returns a referral for the practitioner to complete the MCCD, this must go to the medical examiner’s office.

CN1A and CN1B forms (returned by the coroner) mean no investigation required, so the referral needs to then go the medical examiner’s office.
 

What to do if you are unsure of the coroners advice?

Please speak to your medical examiner – they are there to help support and ensure the right process is followed

 

What does a medical examiner do?

Medical examiners (ME) are senior clinicians who act in a supportive role:

• agree the proposed cause of death with the doctor completing death certificate 
• discuss the cause of death with the next of kin/informant and establish if they have questions or any concerns with care before death
• identify potential learning and compliments to contribute to clinical governance procedures.

Will the new process cause delays to the bereaved?

There are additional steps in the process but they should not cause undue delays for the bereaved. Medical examiner review should happen within 24 hours. The GP will need to respond to the medical examiner review and together agree a cause of death. The final certificates will continue to be sent electronically to the registrar by the Medical Examiner.

The practice will need to inform bereaved relatives that they will receive a call from the Medical Examiner's office. Other than this call bereaved relatives/next of kin should not notice a difference in process.

Why is the medical examiner calling the family?

The medical examiner or medical examiner officer has the responsibility to ask the family if they had any concerns about the care of the deceased. This is the case even if the regular GP has been present in the home or visited afterwards as the medical examiner service is independent.

It also provides an opportunity for the bereaved to speak to someone independent of the deceased's care about their treatment.

What is the process - how will practices be informed of a death?

There is no change to the way that the practice will hear about a death in the community. Most are communicated from the relatives or friends of the bereaved, others from the out of hours GP service or community nurses, or the practice may receive a notification of deduction.

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How do we get the practice ready for the change?

Information will be shared with practices, but if you would like to talk to someone about getting your practice set-up. Please email: tsmith8@nhs.net
 

Who is my medical examiner– how do I contact them?

If you have any questions, please contact your local medical examiner office.

 

Borough of patient death	Medical examiner service base	Medical examiner office email
Hillingdon	Hillingdon Hospital	Thh.me-community@nhs.net
Harrow	London NW University Healthcare (Northwick Park)	LNWH-tr.medicalexaminerharrow@nhs.net
Hounslow	West Middlesex Hospital	chelwest.bereavementteam.wmuh@nhs.net
Brent	London NW University Healthcare (Northwick Park)	LNWH-tr.medicalexaminerbrent@nhs.net
Ealing	London NW University Healthcare (Northwick Park)	LNWH-tr.medicalexaminerealing@nhs.net
Royal Borough of Kensington and Chelsea	Chelsea and Westminster Hospital	Chelwest.medicalexaminer@nhs.net
Hammersmith and Fulham	Imperial College Healthcare	Imperial.medicalexaminer@nhs.net
Westminster	Imperial College Healthcare	Imperial.medicalexaminer@nhs.net

 

What resources will be available to help train staff?

Information for practice staff, IT training support and information for the public can all be found on these pages.

Information is regularly shared with practices, therough the bulletin and email to ensure they are set up correctly on SystmOne/EMIS.

You can also listen to this national podcast.