NEW: Medical examiner process

Preparing for the statutory rollout of the medical examiner system 

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). 

Many of our practices are now set up with the new IT system and referring deaths through the medical examiner’s office. We will continue to set up and support all practices with this new IT system ahead the national rollout (date TBC).

The new process requires practices being set-up on SystemOne and EMIS

The medical examiner system has been successfully running in our acute trusts for several years and the full rollout to
primary care completes the final stages of the nationwide process.   

On this page (in the drop downs below) you will find:

  • Training guides to get your practice setup on SystmOne/EMIS
  • Frequently asked questions for practice staff
  • Guidance for completing the Medical Certificate of Cause of Death MCCD
  • Information for the public
  • Contact details
Quick overview - What does this mean for GP practices?  

The change means that all deaths in the community (except clear coroner referrals) will need to be referred to the medical examiner office before a death certificate can be provided. Referral to the medical examiner will be through SystemOne/EMIS

The process should not cause undue delays for the bereaved and the final certificates will continue to be sent electronically to the registrar by the practice.   

For the public they will not need to do anything differently.

As part of the process the medical examiner will speak to the bereaved and talk through any questions they have.

The process map for this new referral process can be found here.

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:

SystemOne - 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 is coming to all GP practices (under legislation in the 2022 Health and Care Act).

The medical examiner system has been successfully running in our acute trusts for the last two 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.

The service so far has received positive feedback.

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.

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 will I know when the change has come into effect?

The process is required by law  - we are still waiting for a confirmed national date. Practices will be contacted to confirm this date.

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.

 

Guidance for GPs completing a Medical Certificate of Cause of Death (MCCD)


Can you complete the MCCD for your patient?

In order to complete an MCCD;

  • You must have attended the patient during their last illness
  • You must have seen them F2F or had a video call where you saw them within the last 28 days of life or you must see them after death
  • You must be able to identify the cause of death “to the best of your knowledge and belief”
  • You must be clear the patient does not need referral to the coroner

The family are legally obliged to register the death within five calendar days of the death. Please prioritise completing the MCCD to support bereaved families and so this deadline can be achieved.

When to refer a death to the Coroner

A death should be referred to the coroner if;

  • The cause of death is unknown
  • The deceased was not seen by the certifying doctor either after death or within 28 days before death
  • The death was a result of the patient having surgery or a procedure
  • The death was violent or unnatural or was suspicious
  • The death may be due to an accident (whenever it occurred)
  • The death may be due to self-neglect or neglect by others
  • The death may be due to an industrial disease or related to the deceased’s employment
  • The death may be due to an abortion
  • The death occurred during an operation or before recovery from the effects of anaesthetic
  • The death may be suicide
  • The death occurred during or shortly after detention in police or prison custody.
     

The Medical Examiner

All deaths should be discussed with the Medical Examiner service in the borough in which the death occurred. From April 2024 this will be statute but it is good practice now and may help you with and with advice, such as;

  • whether you can complete the MCCD
  • the need for referral to the coroner
  • wording the MCCD – for instance words like “probable” or “possible” are not acceptable and will result in the registrar referring to the coroner
  • order of the MCCD - you must ensure that 1c lead to/caused 1b and 1b must lead to/ cause 1a.
  • what to put in II – these are underlying conditions which contributed to the death (and not every condition in the patient’s past medical history)

How to complete the MCCD

When you complete the MCCD following your discussion with the ME, please ensure you

  • Complete the cause of death as agreed with the Medical Examiner
  • Write clearly – please sign and print your name
  • Do not use any abbreviations on the main certificate
  • Residence - is the name of your GP practice
  • Place of death – is the full address of where the patient died including postal code.
  • Qualifications-  Please include your GMC number along with your qualification
  • If have met the patient in life but you have NOT seen them within the last 28 days and you know the cause of death you can see the body after death and issue the MCCD. Write the date you last saw the patient under “last seen by me” and circle “seen after death by me”
  • Write the code number given to you by the Medical Examiner Service on the top edge of the MCCD. This ensures the registrar of deaths knows that you have discussed this case with the Medical Examiner Service.

When you have completed the MCCD please email it to the appropriate registry office and ask the family to book an appointment to register the death. The original certificate can be discarded confidentially after 12 weeks. There is no longer any requirement to post it to the registry office.

How to complete the MCCD flowchart

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What happens after a loved one dies and how do you go about registering the death?

This information has been provided to introduce you to the role of the medical examiner and explain why they will call the next of kin following a bereavement.

Watch our video or read more below.

Losing a loved one is never easy and it can be difficult and confusing having to think about what you need to do to register the death when you are grieving.

To help you understand the process we’ve put together a simple guide of what happens next and what you will need to do.
 

1. Phone call from the medical examiner’s office

As soon as possible after the death (on average within 24 hours) the next of kin will receive a phone call from the medical examiner’s service. This service provides an independent review of the cause of death and gives the next of kin time to ask questions.

(Medical examiners are senior medical doctors who provide independent scrutiny of the causes of death. They are trained in the legal and clinical elements of death certification processes. The medical examiner’s service was rolled out nationally on 1 April 2023 to all community and GP services. You can find out more here).

The medical examiner’s office will be able to:

  • confirm your loved one’s cause of death
  • discuss the care they received
  • answer your questions, and concerns
  • explain the wording on the death certificate agreed by the doctor and medical examiner.
     

If the cause of death is unknown, they will also be able to talk you through the referral process to the coroner (if required).

Following your call with the medical examiner’s office the medical certificate of cause of death will then be electronically sent by the GP/doctor straight to the registrar in the borough the death was recorded. You will then be able to book an appointment to register the death.

You do not need to visit the GP surgery to collect the medical certificate of cause of death.
 

2. Registering the death

A death must be registered within five days.

To register you will need to book an appointment with the registrar in the borough that the death occurred in. The registrar will need the medical certificate of cause of death to do this.

Please use the links below to register in the borough you need;

 

3. Arranging a funeral

A funeral can usually only take place after the death is registered.

There are many things to think about and decide when arranging a funeral. The person may have left plans for the funeral they want, or you may need to arrange the funeral yourself. It can be a good idea to ask family and friends for help. Or you may want to pay for the services of a funeral director, who can take you through the whole process step-by-step.

Whilst planning a funeral, it can be useful to consider: 

  • waiting until you have the medical certificate of death certificate and (green certificate from the registrar for burial or cremation) before finalising any arrangements making any arrangements
  • if the person has left instructions in their will or a letter about their wishes
  • letting people know about the death and funeral details by organising an obituary in a newspaper or other.

More information on arranging funerals on GOV.UK

 

Frequantly asked questions
 

What happens if I miss the phone call from the medical examiner, will it delay the process of the death certificate being issued?

The medical examiner’s office wants to check if you have any concerns about the death before the death certificate is issued. If you miss a call from them they will keep trying to contact you.
 

How will the medical examiner know who to call?
The medical examiner’s office will contact the next of kin registered with the deceased’s GP/doctor.

Do I have to receive this phone call – can I opt out?
The medical examiner’s office will call, if you decide that you don’t need to talk to them for very long that is fine. The service is designed to support the next of kin.

What happens if I don’t speak English – will a translator be provided?
Yes, interpreting services will be available to support bereaved relatives who need them.


Can I call the medical examiner to speed up the process?

Yes, you can contact the office for your borough using the following details

Borough 

Medical examiner service base 

Medical examiner office email 

Hillingdon 

Hillingdon Hospital  

Thh.me-community@nhs.net  

Harrow, Brent, Ealing 

Northwick Park Hospital 

lnwh.tr-medicalexaminer@nhs 

Kensington and Chelsea  Hounslow 

West Middlesex Hospital 

chelwest.bereavementteam.wmuh@nhs.net 

Hammersmith and Fulham, Westminster 

Imperial  

Imperial.medicalexaminer@nhs.net  

 

For religious reasons I need to register the death quickly?
The medical examiner’s office is sensitive to religious needs surrounding burial.  They will make sure they call next of kin as soon as possible within 24 hours of the death.

How long will it take for the medical certificate for cause of death to be issued?

The certificate is issued by the GP after the Medical Examiner review and a discussion between them. In most cases this will be within a day of the death but in some cases may be longer. If the death needs to be referred to the coroner there will be a delay in issuing the death certificate. This will vary depending on what the coroner decides they need to do.

What happens if the death is referred to the Coroner?
Coroners investigate all deaths where the cause is unknown, where there is reason to think the death may not be due to natural causes, or which need an inquiry for some other reason. The GP has a legal duty to report any death that meets the coroner’s referral criteria. The GP or medical examiner’s officer will tell you if the death of your loved one has to be referred.

The coroner will investigate each case in an appropriate way. It may be as simple as consulting with the doctor who last treated the person who has died, or a post mortem examination may be needed. 

In some cases, the coroner may open an inquest, which is a judicial inquiry into the death. Coroners have the power to have a body brought into the public mortuary and keep it there while they carry out investigations.

For further advice please visit the gov.uk website.

 

You can find out more about the medical examiner service here.

London medical examiner's offices:

Host trust

Lead ME

London boroughs

Office number
and email

Barking, Havering & Redbridge University Hospitals NHS Trust

 

*King George

*Queen’s

 

Dr Peter Tanner

 

Barking & Dagenham

Havering

Redbridge

 

01708 435000

ext 3307 

bhrut.medicalexamineroffice@nhs.net

Barts Health NHS Trust

 

*St Bart’s

*Newham

*The Royal London

*Whipps Cross

Dr William White

 

City of London

Newham

Tower Hamlets

Waltham Forest

 

St Bartholomew’s

020 3465 6470

 

Newham

020 7363 8055

 

Royal London

07842 323392

 

Whipps Cross

020 8539 5522 ext. 4399 & 4398

 

bartshealth.bhtmedicalexaminerservice@nhs.net

Chelsea & Westminster Hospital NHS Foundation Trust

 

*Chelsea & Westminster

*West Middlesex

 

Dr Sarah Cox

(Chelsea)

 

 

 

Dr Elora Mukherjee

(West Mid)

 

 

Hounslow

Kensington & Chelsea

0203 315 8650

Chelsea

 

chelwest.medicalexaminer@nhs.net

West Middlesex

chelwest.bereavementteam.wmuh@nhs.net

Croydon Health Services NHS Trust

 

*Croydon

 

Mr Gregory Ward

 

Croydon

 

0208 401 3719

ch-tr.medicalexaminer@nhs.net

Epsom & St Helier University Hospitals NHS Trust

 

*Epsom

*St Helier

 

Dr Sally Lewis

 

Sutton

020 8296 2493

esth.medex@nhs.net

Guy’s & St Thomas’ NHS Foundation Trust

 

*Guy’s

*St Thomas’

* Royal Brompton

* Harefield

 

           

Dr Luke Smith (GSTT)

 

 

Dr Sarah Trenfield (RB & H)

Lambeth

Southwark

020 7185 2608 (GSTT)

medicalexaminer@gstt.nhs.uk

 

 

 

 

Harefield

01895 828638

 

gst-tr.medicalexaminer@nhs.net

 

 

Royal Brompton 0207 352 8121 ext 82268

 

MedicalExaminerService@rbht.nhs.uk

 

Homerton University Hospital NHS Foundation Trust

*Homerton

Dr Nicola Radford

 

Hackney

 

0208 510 7150

Huh-tr.medicalexaminer@nhs.net

 

Imperial College Healthcare NHS Trust

 

*Charing Cross

*Hammersmith

*Queen Charlotte’s & Chelsea

*St Mary’s

*Western Eye

 

Dr Susannah Long

 

 

 

Hammersmith & Fulham

Westminster

 

 

Hammersmith

0203 313 3075 

 

Charing Cross

0203 311 1098 

 

St Mary's Hospital

0203 312 3325

 

imperial.medicalexaminer@nhs.net

King’s College Hospital NHS Foundation Trust

 

*Kings College

*Princess Royal University Hospital

 

Dr Yasmin Kapadia

 

Bexley

Bromley

 

 020 3299 34051

kch-tr.meoffice@nhs.net   

Kingston Hospital NHS Foundation Trust

 

*Kingston

 

Mr Andrew Pooley

 

Kingston

Richmond

 

 020 8934 3478

khft.medicalexaminers@nhs.net

Lewisham & Greenwich NHS Trust

 

*University Hospital Lewisham

*Queen Elizabeth Hospital, Woolwich

Dr Charles Mazhude

 

Greenwich

Lewisham

QEH

0208 836 4626

UHL

0203 192 6045

lg.medicalexaminerofficecommunitylgt@nhs.net

 

London NW University Healthcare NHS Trust

 

*Central Middlesex

*Ealing

* Northwick Park

* St Mark’s

 

Dr Glynn Evans

 

Brent

Ealing

Harrow

 

Northwick Park And St Mark’s Hospitals  
020 8869 5849

Ealing and Central Middlesex Hospitals  
020 8967 5740

lnwh-tr.medicalexaminer@nhs.net

North Middlesex University Hospital NHS Trust

 

*North Middlesex

Dr Rebecca Gillibrand

 

Enfield

Haringey

 

northmid.medicalexaminer@nhs.net

Royal Free London NHS Foundation Trust

 

*Barnet

*Chase Farm

*Royal Free

 

Dr Rachel Craig

 

Barnet

Royal Free Hospital:

020 7472 6393

rf-tr.rfmeo@nhs.net

 

 

Barnet Hospital:

020 8216 4744

rf-tr.bhmeo@nhs.net

The Royal Marsden NHS Foundation Trust

 

*RMH – Chelsea

*RMH - Sutton

Mr Cyrus Kerawala (Fulham)

 

 

Mr Jonathan Handy (Sutton)

 

 

N/A

Chelsea

0207 808 2012

 

Sutton

0208 915 6778

St George’s University Hospital NHS Foundation Trust

 

*St George’s

* Queen Mary’s Roehampton

 

Dr Nigel Kennea

 

Merton

Wandsworth

 

0208 725 4317

Medicalexaminer@stgeorges.nhs.uk

The Hillington Hospitals NHS Foundation Trust

 

*Hillingdon

* Mount Vernon

Dr Jeremy Weinbren

 

Hillingdon

01895 2793354

thh.medicalexaminer@nhs.net

University College London Hospitals NHS Foundation Trust

(plus Great Ormond Street and Moorfields)

 

*University College Hospital

 

*National Hospital for Neurology and Neurosurgery

 

*Hospital for tropical diseases

 

*Royal National ENT and Dental Hospitals

 

 

Dr Sally Wilson

 

Camden

0203 447 5130

0203 447 5129

uclh.medicalexaminer@nhs.net  

 

 

uclh.camdenme@nhs.net

 

Whittington Health NHS Trust

*Whittington

Dr Francesca Silman

 

Islington

020 7288 5680

whh-tr.medicalexaminer@nhs.net

 

 

 

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