Death certification processes: information for medical practitioners after the Coronavirus Act 2020 expires
Publication approval reference: C1566
The Coronavirus Act 2020, which introduced easements to death certification processes and cremation forms, expired at midnight on 24 March 2022. Some changes have been retained on a permanent basis through other measures. Other processes revert to previous practice. This document summarises the position following expiry of the Coronavirus Act.
1. Medical certificate of cause of death
The Office for National Statistics and HM Passport Office (General Register Office) jointly publish guidance for doctors completing medical certificates of cause of death in England and Wales.
It should be noted that the provision for any medical practitioner to complete the medical certificate of cause of death (MCCD), introduced as a temporary measure by the Coronavirus Act 2020, discontinued at midnight on 24 March 2022, therefore attendance requirements will revert to those prior to the Act.
a. In all cases, without exception, only a medical practitioner who has attended the deceased for their last illness, and can state the cause of death to the best of their knowledge and belief, will be allowed to complete a MCCD. In addition, the attending medical practitioner must meet the requirements set out in paragraph 1(b); if not, paragraph 1(c) will apply.
b. In addition to 1(a), an attending medical practitioner* with GMC registration will be able to complete the MCCD process if they saw the deceased during their final illness up to 28 days before death, or viewed the body in person after death; otherwise 1(c) will apply.
- i. The 28 day provision (the ‘last seen alive’ requirement), initially introduced in response to the coronavirus pandemic, has now been made permanent through a change to regulations and included in the MCCD guidance**. ‘Seen’ in this context includes consultation using video technology. However, it does not include consultation by telephone/audio only.
- ii. Seeing the deceased after death (i.e. viewing the body) will need to be in person and includes verifying the death.
*An “attending medical practitioner” in this document means a medical practitioner who meets the attendance requirement in paragraph 1 (a)
**Prior to the Coronavirus Act 2020, it was a requirement that the medical practitioner had attended the deceased within 14 days.
c. Requirements are different if the attending medical practitioner did not see the deceased in the 28 days before death, or the deceased was not seen after death by the attending medical practitioner. While the MCCD can still be completed by the attending medical practitioner if they meet the requirements in 1(a), the registrar is obliged to refer the death to the coroner before registration. Preferably the attending medical practitioner should notify the coroner beforehand, to avoid distress to the bereaved. The coroner will then consider if the case requires further investigation, and if not, will complete Form 100A and send this to the registrar to allow registration.
d. The MCCD can be scanned or photographed and sent from a secure email account to registrars as an attachment. Registrars should determine the appropriate email address to which the MCCD is sent – for example, a secure email account. It is important that a qualified informant is aware the MCCD has been completed.
a. As noted in 1(e), MCCDs can continue to be scanned or photographed and sent by email to registrars as an attachment. We continue to recommend that electronic transfer of MCCDs is used as standard practice to accelerate
processes. However the next of kin/informant will need to register the death in person.
b. Where electronic transfer is not possible, a paper MCCD can still be issued to a qualified informant for them to deliver to the registrar.
c. An informant can be someone who is closely related; who was present at the death; a hospital official; or someone who is arranging the funeral (i.e. someone who is instructing the funeral director).
a. National guidance regarding notification of deaths to coroners by medical practitioners is here. The Chief Coroner has provided information on the law for coroners (see guidance sheet No. 34).
Where an urgent burial is required it may be possible for the registrar to issue the required form (the green form) prior to registration. This is subject to certain provisions being met, and is offered by some registrars as an out-of-hours service. It is expected that the registration will take place as soon as possible after the green form has been issued. The coroner can also issue similar documents subject to certain conditions. The National Medical Examiner has published information about how urgent release of bodies can be facilitated.
The Ministry of Justice publish Medical practitioner guidance on completing cremation forms.
a. The requirement to complete a confirmatory medical certificate (form Cremation 5) was temporarily removed by the Coronavirus Act which expired on 24 March 2022. It is the government’s intention that it will not be re-introduced after the expiry date. Unless otherwise notified, cremations can continue to be authorised on the basis of one medical certificate (form Cremation 4), without the requirement to also complete form Cremation 5.
b. An attending medical practitioner will be able to complete the form Cremation 4 if they saw the deceased (including visual/video consultation) within 28 days before death, or viewed the body in person after death (including for verification). The requirements will therefore be the same as those for the MCCD set out in paragraphs 1(a) to 1(c). The form is an interactive PDF document and can be completed and saved before sending, or paper copies can be scanned/photographed and submitted electronically. Electronic signature includes being sent from the secure email account of the person completing the form Cremation 4.
c. The form Cremation 10 will continue to be completed by the crematorium medical referee.