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 were asked to set 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 are 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 of cause of death (MCCD) with the doctor completing it
  • discuss the cause of death with the next of kin/informant and establish if they have questions or any concerns with care before death
  • act as a medical advice resource for the local coroner
  • inform the selection of cases for further review under local mortality arrangements and contribute 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.

Medical examiner service in Wales

For the medical examiner service in Wales see NHS Wales’ website.

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 2020, also included in the document for completeness.

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.

Funding for medical examiners

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 will provide adequate cover and should be used as a guide to reasonable costs. 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.

Reimbursement process

Regional support

Each NHS region has regional medical examiner and a regional medical examiner officer to support medical examiner offices. Regional medical examiners 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 issue regular updates providing useful information and news to support medical examiner offices.

  • National medical examiner update – February 2021 – includes details of the medical examiners’ annual conference, working with the Chief Coroner, details of the Good Practice Series- BAME paper, excess deaths and potential delays, a digital update, medical examiner recruitment, updates on implementation in England and Wales, quarterly reporting, and training and events.
  • National medical examiner update – December 2020 – includes details of the medical examiners’ annual conference, working with registrars, updates on implementation in England and Wales, funding and quarterly reporting, and training and events.
  • National medical examiner update – October 2020 – includes details of the good practice series, review of Coronavirus Act, updates on implementation in England and Wales, funding and reporting, and training and events
  • National medical examiner update – August 2020 – 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 – 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 – 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 – 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 – 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 – 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 – 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 – 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 – 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.

Good Practice Series

The Good Practice Series is a topical collection of focused summary documents, designed to be easily read and digested by medical examiners and other busy front-line staff, with links to further reading, guidance and support.  Papers are published by the Royal College of Pathologists as follows:

Events and training

Medical examiners’ annual conference

The Royal College of Pathologists is hosting the first medical examiners’ annual conference on 27 April 2021.  Speakers include Nadine Dorries MP, Minister for Patient Safety, Sir Robert Francis QC (Chair, Healthwatch England), and Keith Conradi (Chief Investigator, HSIB). Places can be booked via the Royal College of Pathologists.

Implementing medical examiner events

The Royal College of Pathologists (RCPath) host a series of events on implementing medical examiners, the last of which 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 webpage.

Medical examiner officer 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 officer training webpage.

The medical examiner officer training record and supporting documents are available on the RCPath webpage.

National exemplar forms

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.

National and regional contacts

England

National Medical Examiner’s office contacts:

Regional medical examiner offices:

East of England

London

Midlands

North East and Yorkshire

North West

South East

South West

Wales