The national medical examiner system

A new medical examiner system is being rolled-out across England and Wales to provide greater scrutiny of deaths.


Contents


Introduction to the medical examiner system

The system will also offer a point of contact for bereaved families to raise concerns about the care provided prior to the death of a loved one.

Acute trusts in England and local health boards in Wales have been asked to begin setting up medical examiner offices to initially focus on the certification of all deaths that occur in their own organisation.

The purpose of the medical examiner system is to:

  • provide greater safeguards for the public by ensuring proper scrutiny of all non-coronial deaths
  • ensure the appropriate direction of deaths to the coroner
  • provide a better service for the bereaved and an opportunity for them to raise any concerns to a doctor not involved in the care of the deceased
  • improve the quality of death certification
  • improve the quality of mortality data.

Medical examiners

Medical examiners are senior medical doctors who are contracted for a number of sessions a week to undertake medical examiner duties, outside of their usual clinical duties. They are trained in the legal and clinical elements of death certification processes.

Medical examiner offices at acute trusts in England

Medical examiner offices at acute trusts will be staffed by a team of medical examiners, supported by medical examiner officers.

The role of these offices is to examine deaths to:

  • agree the proposed cause of death and the overall accuracy of the medical certificate cause of death
  • discuss the cause of death with the next of kin/informant and establishing if they have any concerns with care that could have impacted/led to death
  • act as a medical advice resource for the local coroner
  • inform the selection of cases for further review under local mortality arrangements and contributing to other clinical governance procedures.

Initially medical examiner offices are being asked to focus on the certification of deaths that occur within the acute trust where they are based. In time, they will be encouraged to work with local NHS partners and other stakeholders to plan how they can increase the service to cover the certification of all deaths within a specified geographical area. This will expand the service to cover deaths in other NHS and independent settings, as well as deaths in the community.

During the non-statutory phase of implementation we, along with the Department of Health and Social Care, will collectively support acute trusts to manage the financial impact of establishing and running local medical examiner offices.

Coronavirus Act – excess death provisions: information and guidance for medical practitioners

National Medical Examiner’s good practice guidelines

To support medical examiners to ensure there is consistency in the implementation of medical examiner offices, we have produced good practice guidelines setting out how the National Medical Examiner expects medical examiner offices to operate during the current non-statutory phase of the programme. The document sets out good practice from the National Medical Examiner, and learning from pilot sites and early adopters.

How reasonable costs for operating a medical examiner system will be determined

It is anticipated that for approximately 3,000 deaths, one whole time equivalent medical examiner (from a pool of varying specialities on a rota) and three whole time equivalent medical examiner officers should provide adequate cover and should be used as a guide to reasonable costs. However, this is an estimate and can be tested during the non-statutory period. It will be recommended that organisations with significantly lower numbers of deaths work with another medical examiner office rather that setting up their own system.

Funding for medical examiners

On 11 September 2019, we issued a letter with the Provider Bulletin to give trust and foundation trust medical directors (cc chief executives and finance directors) further information on what the introduction of medical examiners in England means for their organisation. The annexe to the letter is available below, and provides details on the regional structure, the digital system and plans for funding the system.

Reimbursement process 2019/20 and 2020/21

The National Medical Examiner team has published an explanatory note on the reimbursement process for trusts and foundation trusts for 2019/20 and 2020/21. If your organisation is planning to submit a request for top-up funding for your medical examiner system, please read this note and contact funding.nme@nhs.net if you have any queries.

Regional support

Each NHS region will have a regional medical examiner to support the development of medical examiner offices. Regional medical examiners will oversee the provision of services and provide an independent line of advice and accountability for medical examiners at trusts in their region.

The national medical examiner

In March 2019, Dr Alan Fletcher was appointed as National Medical Examiner for England and Wales.

The role of the national medical examiner is to provide professional and strategic leadership to regional and trust-based medical examiners. The role supports better safeguards for the public, patient safety monitoring and improvement, and informs the wider learning from deaths agenda.

The office of the national medical examiner can be contacted by emailing: nme@nhs.net.

National medical examiner updates

We will be issuing regular ‘National medical examiner updates’ providing useful information and news to support providers in the process of establishing medical examiner offices.

  • National medical examiner update – August 2020 – This update includes details of deaths of people with a learning disability in England, medical examiner funding and reporting in England, implementation in Wales, role of the medical examiner officer, and training and events.
  • National medical examiner update – July 2020 – This update includes details of scrutiny of staff COVID-19 deaths, quarterly reporting, cause of death list, implementation in Wales, and training and events.
  • National medical examiner update – June 2020 – This update includes details of recommencing medical examiner scrutiny and implementation, implementation in Wales, medical examiner activity reporting, regional and national teams, lay representation in England, reimbursement in England, and training and events.
  • National medical examiner update – January 2020 – This update includes details of good practice guidelines, funding, regional infrastructure in England, implementation in Wales, learning from deaths guidance for ambulance trusts in England, and training.
  • National medical examiner update — December 2019 – This update includes details of the national and regional infrastructure, good practice guidelines, funding for the national medical examiner system, and medical examiner and medical examiner officer training.
  • National medical examiner update — September 2019 – This update includes details of the national and regional infrastructure, funding the medical examiner system, medical examiners and referrals to coroners, working with registrars and training.
  • National medical examiner update – August 2019 – This update includes details of the appointment of regional medical examiners and lead medical examiner for Wales, recruiting regional medical examiner officers and lead medical examiner officer for Wales, Medical examiner training, medical examiner system in Wales, setting up local medical examiner offices, Children’s Funeral Fund for England, and notification of deaths regulations.
  • National medical examiner update – June 2019 – This update includes details of the role of medical examiner officers, neonatal and child deaths, alignment with Learning from Deaths and recruitment to local medical examiner posts.
  • National medical examiner update – May 2019 – This update includes details of the recruitment to national and regional roles, arrangements for funding and reimbursements for trusts and health boards, the piloting of a digital system to support medical examiner offices, and details on extending the medical examiner service to community deaths.

Events and training

Implementing medical examiner events

The Royal College of Pathologists (RCPath) has been hosting a series of events on implementing medical examiners, the most recent took place on 25 April 2019. A report from the event is available on the RCPath website.

Medical examiner training

Medical examiner training involves the completion of 26 core e-learning modules, followed by attendance at a face-to-face training day. More details can be found on the RCPath medical examiner training web page.

National exemplar forms

Coronavirus Act – excess death provisions: information and guidance for medical practitioners

The Coronavirus Act of Parliament gained Royal Assent on 25 March 2020, and the commencement order for the clauses relating to death certification and cremation forms was signed on 26 March 2020. Guidance and information on these clauses are set out in the document below, along with previous COVID-19 advice issued on 10 March,* included here for completeness.

Appraisal and revalidation of medical examiners

The Royal College of Pathologists has produced the document Supporting information for appraisal and revalidation, including specialty specific information for medical examiners (of the cause of death).

National and regional contacts

England

National Medical Examiner’s office contacts:

Regional medical examiner offices:

East of England

Regional medical examiner: Ellen Makings ellen.makings1@nhs.net

Regional medical examiner office: Siobhan Costello siobhan.costello@nhs.net

London

Regional medical examiner: Mette Rodgers metterodgers@nhs.net

Regional medical examiner office: Laura O’Donoghue laura.odonoghue1@nhs.net

Midlands

Regional medical examiner: Ben Lobo benjamin.lobo@nhs.net

Regional medical examiner office: Siobhan Costello siobhan.costello@nhs.net

North East and Yorkshire

Regional medical examiner: Graham Cooper graham.cooper11@nhs.net

Regional medical examiner office: Debbie Peacock Debbie.Peacock2@nhs.net

North West

Regional medical examiner: Huw Twamley huw.twamley@nhs.net

Regional medical examiner office: Margaret Butler margaret.butler2@nhs.net

South East

Regional medical examiner: Zoe Hemsley zoe.hemsley1@nhs.net

Regional medical examiner office: Amanda Dooley Amanda.Dooley1@nhs.net

South West

Regional medical examiner: Golda Shelley-Fraser Golda.shelley-fraser@nhs.net

Regional medical examiner office: Becky Protopsaltis rebecca.protopsaltis@nhs.net

Wales