A new medical examiner system is being rolled-out across England and Wales to provide greater scrutiny of deaths.
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 on a non-statutory basis. In February 2021, the government published Working together to improve health and social care for all, the white paper which includes provisions for medical examiners to be put on a statutory footing. During 2021/22, the role of these offices is being extended to include all non-coronial deaths, wherever they occur. Implementation of this next phase will take place incrementally, to allow time for capacity and processes to be put in place.
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 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 in England are hosted by acute trusts (and a small number of specialist trusts). They 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.
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.
During 2021/22, the services provided by medical examiner offices will start to be extended beyond acute trusts to provide independent scrutiny of all non-coronial deaths, wherever they occur. Implementation of this next phase will happen incrementally, to allow time for capacity and processes to be put in place.
Each medical examiner office will lead work to establish arrangements with local health and care providers in their area, supported by regional medical examiners where needed.
On 8 June 2021 we sent a system wide letter setting out what local health systems now need to do to implement the national medical examiner system for scrutiny of non-coronial deaths across all health settings. We have also created an additional webpage providing specific information for colleagues working in primary care.
For the medical examiner arrangements in Wales see NHS Wales’ website.
Death certification processes and cremation forms after the Coronavirus Act 2020 expires – information and guidance for medical practitioners
The Coronavirus Act 2020, which introduced easements to death certification processes and cremation forms, expired at midnight on 24 March 2022. Some changes were retained on a permanent basis through other measures, and other processes revert to previous practice.
The following provisions are continuing after 24 March 2022:
- The period before death within which a doctor completing a Medical Certificate of Cause of Death (MCCD) must have seen a deceased patient will remain 28 days (prior to the coronavirus pandemic, the limit was 14 days).
- It will still be acceptable for medical practitioners to send MCCDs to registrars electronically.
- The government’s intention is that the form Cremation 5 will not be re-introduced after the Coronavirus Act expires.
The following emergency provisions are changing with the expiry of the Coronavirus Act on 24 March 2022:
- The provision temporarily allowing any medical practitioner to complete the MCCD, introduced as a temporary measure by the Coronavirus Act, was discontinued on 24 March 2022.
- Informants will have to register deaths in person, not remotely.
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.
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. During the non-statutory phase, the National Medical Examiner’s office agrees a funding envelope with each medical examiner office each year.
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.
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: firstname.lastname@example.org.
We issue regular updates providing useful information and news to support medical examiner offices.
Each year the National Medical Examiner publishes a report to show progress with implementing the medical examiner system, milestones achieved, examples of the impact medical examiners are having, and details of key activity during the period covered by each report.
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 frontline staff, with links to further reading, guidance and support. Good Practice papers are published by the Royal College of Pathologists.
The lead college for medical examiners is 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 – Administrative Information – Form ME-1 (Part A)
- National exemplar – Medical Examiner’s Advice and Scrutiny – Form ME-1 (Part B)
- National exemplar – Summary of Death Certification form
The Royal College of Pathologists has produced the document supporting information for appraisal and revalidation, including specialty specific information for medical examiners.
National Medical Examiner’s office contacts:
- For general enquiries: email@example.com
- For funding enquiries: firstname.lastname@example.org
- For quarterly reporting enquiries: email@example.com
Regional medical examiner offices:
East of England
- Regional medical examiner: Ellen Makings firstname.lastname@example.org
- Regional medical examiner office: Siobhan Costello email@example.com
- Regional medical examiner: Mette Rodgers firstname.lastname@example.org
- Regional medical examiner office: Laura O’Donoghue email@example.com
- Regional medical examiner: Ben Lobo firstname.lastname@example.org
- Regional medical examiner office: Siobhan Costello email@example.com
North East and Yorkshire
- Regional medical examiner: Graham Cooper firstname.lastname@example.org
- Regional medical examiner office: Debbie Peacock Debbie.Peacock2@nhs.net
- Regional medical examiner: Huw Twamley email@example.com
- Regional medical examiner office: Margaret Butler firstname.lastname@example.org
- Regional medical examiner: Zoe Hemsley email@example.com
- Regional medical examiner office: Amanda Martin Amanda.Martin34@nhs.net
- Regional medical examiner: Golda Shelley-Fraser Golda.firstname.lastname@example.org
- Regional medical examiner office: Becky Protopsaltis email@example.com