The national medical examiner system

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

Introduction to the medical examiner system

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

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

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.

Extending medical examiner scrutiny to all non-coronial deaths

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.

Medical examiners in Wales

For the medical examiner arrangements 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. During the non-statutory phase, the National Medical Examiner’s office agrees a funding envelope with each medical examiner office each year.

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 reports

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.

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

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